The ATSDR Adult Exposure History Questionnaire covers all the important aspects you will need to determine if your patient’s illness may be due to exposure to environmental agents. The form provides all the questions necessary to acquire an accurate exposure history from your patients. The form is four pages in length and is in a writeable PDF format that can be accessed on any computer operating system.

ATSDR Adult Exposure History Questionnaire

For questions, comments, or help with any aspect of this program, please contact Cynthia Noraian at noraianc@karmanos.org (248-336-2310).