Mold Environmental Questionnaire for Healthcare Professionals

Form Template

The Mold Environmental Questionnaire mobile app, is designed for the patient to fill out independently in a few minutes.

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It consists of a set of questions that explore moisture and mold in the patient’s home, school, or work environment. Any positive response (except to questions on environmental tobacco smoke) may indicate uncontrolled moisture with a corresponding potential for biological growth. We recommend providing these patients (who presented with sentinel conditions or have temporal patterns of concern) with the list of suggested references.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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