Contact Cornerstone Mold

Suspect a mold problem? We’re your first call.

Name

Phone Number

Building needing the inspection

symptoms

Concerns

Message

Name

Phone

Have you experienced any of these symptoms?

Coughing Chronic Bronchitis Asthma Nausea Diarrhea Heart Palpitations Weight Loss/Weight Gain Chronic Fatigue Sexual Dysfunction

Have you experienced any of these symptoms?

Headaches Eye Irritation Sneezing Itching Memory Loss Blurred Vision Ear Infections Chronic Sinusitis Nose Bleeds

Have you been diagnosed with any of these ailments?

Fibromyalgia Rheumatoid Arthritis Inflammation Lupus COPD Hypersensitivity Pneumonitis Lyme Disease Cancer Histoplasmosis

Have you had any water leaks in the environment?

Yes No

Do you see any water stains on the walls or ceiling?

Yes No

Is there visible mold growth on the wall, ceiling, or floors?

Yes No

Does your environment have elevated humidity?

Yes No

Have you noticed any musty or mildew smells in the environment?

Yes No