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The Lyme Disease Questionaire- Is Lyme Affecting Your Life?

Updated: Mar 31, 2023

Do you suffer with chronic illness and malaise? Are you unsure what the cause of your symptoms is? Are you desperate to get your health back on track? Complete our Lyme disease questionnaire and find out today if it's this bacterial infection causing/contributing to your symptoms.

What Is Lyme Disease?

Lyme disease is an infection caused by the bacterium Borrelia Burgdorferi. Borrelia is most frequently transferred by a tick bite, however, may be transferred through mosquito bites, blood transfusions, pregnancy etc. Ticks and mosquitos typically get the bacterium by biting infected animals such as deer and mice. The chance of contracting Lyme disease increases the longer a tick is attached to the body, however, not all ticks are infected. It is common for someone to contract both Borrelia and co-infections such as Bartonella and Babesia from the same source, thus, symptoms will be increased.


How Does This Questionnaire Work?


In each category, mark 1 point for each symptom present. At the end of each category you will add the marks and either land in band 0, 1, 2 or 3. Do this for each category until you add up your band points at the end of the questionnaire.


Category A

  • Unexplained fevers, chills sweats or flushing

  • Unexplained weight gain or loss

  • Chronic fatigue

  • Swollen glands

  • Sore throat

  • Testicular or pelvic pain

  • Unexplained menstrual irregularity

  • Unexplained breast milk production

  • Breast pain

  • Irritable bladder/ bladder dysfunction

  • Loss of libido

  • Stomach upset

  • Diarrhoea/constipation or fluctuations between the 2

  • Chest pain or rib soreness

  • Shortness of breath

  • Cough

  • Heart palpitations

  • Heart arrhythmia (pulse skips)

  • History of a heart murmur or valve prolapse

  • Joint pain or swelling

  • Carditis

  • Back or neck stiffness

  • Muscle cramps or pain

TOTAL CATEGORY A BOXES MARKED:

0-2 boxes marked = Score 0

3-5 boxes marked = Score 1

6-9 boxes marked = Score 2

10+ boxes marked = Score 3

Category A total score: ..........


Category B

  • Twitching of the face or other muscles

  • Headaches

  • Neck cracks or stiffness

  • Tingling, numbness, burning or stabbing sensations

  • Facial paralysis

  • Double vision

  • Blurry vision

  • Eye floaters

  • Tinnitus

  • Increased motion sickness/ vertigo

  • Light-headed feeling

  • Poor balance

  • Difficulty walking

  • Heart attack

  • Dementia

  • Schizophrenia

  • Tremors

  • Confusion/ difficulty thinking

  • Difficulty with concentration or reading

  • Forgetfulness/ poor short-term memory

  • Disorientation: getting lost, going to the wrong places etc

  • Speech or writing difficulty

  • Mood swings

  • Irritability

  • Depression

  • Insomnia/ sleep disturbances

  • Exaggerated symptoms or worse hangover from alcohol

TOTAL CATEGORY B BOXES MARKED:

0-2 boxes marked = Score 0

3-5 boxes marked = Score 1

6-9 boxes marked = Score 2

10+ boxes marked = Score 3

Category B total score: ..........


Category C

  • Had a tick bite with no rash or flu like symptoms

  • Had a tick bite, an erythema migrans or undefined rash, followed by flu-like symptoms

  • You live in what is considered a Lyme endemic area

  • You have a family member who has been diagnosed with Lyme disease or co-infections

  • Migratory muscle pain

  • Migratory joint pain

  • Tingling/ burning/ numbness that migrates and/or comes and goes

  • Fibromyalgia diagnosis

  • Motion sickness

  • Chronic conjunctivitis

  • Chronic fatigue syndrome diagnosis

  • Autoimmune diagnosis

  • Positive Lyme disease or co-infection test

  • Shin splints

  • Tender soles of the feet

  • Light sensitivity

  • Sound sensitivity

  • Seizures

  • Low blood pressure

  • Difficulty swallowing

  • Decreased sight and/or hearing

  • OCD

  • Paranoia

  • Anxiety and/ or panic attacks

  • Violent outbursts

  • Hallucinations

  • Nausea and/ or vomiting

TOTAL CATEGORY C BOXES MARKED:

0-2 boxes marked = Score 0

3-5 boxes marked = Score 1

6-9 boxes marked = Score 2

10+ boxes marked = Score 3

Category C total score: ..........


Total Lyme Disease Risk Results


CATEGORY A SCORE: +

CATEGORY B SCORE: +

CATEGORY C SCORE: =

TOTAL:


0-4 = Not Likely Lyme Disease Sickness

5-9 = Possible Lyme Disease Sickness

10+ = Probable Lyme Disease or Co-infection Sickness


OTHER THINGS TO CONSIDER: MOULD TOXICITY, MSIDS, LYME DISEASE CO-INFECTIONS, OTHER ENVIRONMENTAL TOXINS (MERCURY, LEAD, PM2.5, GLYPHOSATE, PESTICIDES, VOCs etc), INTESTINAL PARASITES, CHRONIC VIRAL SYNDROMES, INFECTIONS, FOOD SENSITIVITIES, CVIDS OR IMMUNODEFICIENCY SYNDROMES.


This tool is intended as a clinical information aid, and is not intended to diagnose or treat disease. Symptoms listed have been reported in mould illness patients, however, not all symptoms have been proven in scientific studies.

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