Checklists for testing
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Checklists for determining which tests to take
You will see two questionnaires on this page. The first is a “Lyme Questionnaire”, the second is a “Coinfection Checklist”.
Both have been designed by Dr. Armin Schwarzbach to help practitioners distinguish the relative importance of different manifestations resulting from tick bite coinfections and other pathogens.
The Coinfection Checklist has an underlying algorithm, and after you have filled it out we will send you back the ranking (prioritisation) of these coinfections.
It needs to be noted that the “Lyme Questionnaire” does not have an underlying algorithm. It will however give your practitioner a good sense of how your symptoms stack up against the possibility of “Borreliosis” (the causative agent of Lyme Disease). This Lyme Questionnaire does not have a ranking because the first two points on it are “knockout” criteria – i.e., if you have had a tick bite and/or Erythema Migrans (bullseye) rash, then it is probably worthwhile testing for Borrelia (your therapist will know which those tests are, or the Helpline can advise you).
The Coinfection Checklist provides a recommendation of which coinfections to test for with priority based on your symptoms. It is not meant as a diagnosis, treatment or substitute for clinical examination, which must be performed by a doctor/practitioner for any therapy to be decided upon. However, it is a useful tool to help determine which tests may best to be done in order to aid the patient and practitioner in thinking through further steps.
Please give the completed Lyme Questionnaire and Coinfection Checklist to your therapist, or send your checklists by email to email@example.com.
If you wish to download the forms for off-line use then you can do so below.