homepage banner
This Lyme Disease Checklist is not intended to replace the advice of your own physician or other medical professional. You should consult a medical professional in matters relating to health and individuals are solely responsible for their own health care decisions regarding the use of this questionnaire. It is intended for informational purposes only and not for self-treatment or diagnosis.
This is a questionnaire to determine the probability of your having Lyme disease and other tick borne disorders.
Horowitz/MSIDS 38 Point Symptom Checklist
How can we apply to you? *
Unexplained fevers, sweats, chills, or flushing *
Unexplained weight change.....Loss or Gain *
Fatigue, tiredness *
Unexplained hair loss *
Swollen glands *
Sore throat *
Testicular pain / Pelvic Pain *
Unexplained menstrual irregularity *
Unexplained breast milk production, breast pain *
Irritable bladder or bladder dysfunction *
Sexual dysfunction / loss of libido *
Upset stomach *
Change in bowel function (Constipation or Diarrhea) *
Chest pain or Rib soreness *
Shortness of Breath / Cough *
Heart palpitations, pulse skips, heart block *
History of Heart Murmur or Valve Prolapse *
Joint pain or Swelling *
Stiffness of the neck or back *
Muscle pain or cramps *
Twitching of the face or other muscles *
Headaches *
Neck cracks or Neck Stiffness *
Tingling, numbness, burning or stabbing sensations *
Facial Paralysis (Bells Palsy) *
Eyes/Vision – Double, Blurry *
Ears/Hearing – Buzzing, Ringing, Ear Pain *
Increased motion sickness, vertigo *
Light theadedness, poor balance, difficulty walking *
Tremors *
Confusion, difficulty thinking *
Difficulty with concentration or reading *
Forgetfulness, poor short term memory *
Disorientation; getting lost, going to wrong places *
Difficulty with speech or writing *
Mood swings, irritability, depression *
Disturbed sleep – Too Much, Too Little, Early Awake *
Exaggerated symptoms or worse hangover from alcohol *
GDRP Agreement. I consent to having this website my submitted information so they can respond to my inquiry *
The above  Check List belongs to Dr Horowitz who created his Horowitz/MSIDS 38 Point Symptom Checklist.