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  • I may be suffering from this condition

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    month day year
    Date of Birth:
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      month year  
    When did you first notice symptoms?:  
    What geographic region do you associate with
    the onset of your symptoms?
     
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    Does anyone else in your home have this condition?

     

    Have you sought medical assistance?
    If yes, number of physicians consulted:

    Please check if you have experienced the following symptoms:
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    Biting or Stinging
    Black Specks
    Crawling Sensation
    Fibers or Fuzzy Artifacts
    Itching
    Lumps on Head
    Salt-like Crystals
    Scaling Skin
    Scarring
    Skin Discoloration
    Sores or Lesions
     

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The National Pediculosis Association,® Inc.
A Non-Profit Organization
Serving The Public Since 1983.

2017 marks 34 years of Service.

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