Date: _______________

To the clinician seeing me today

I am here for skin sensations and lesions that have lasted _______________ (weeks / months / years). I use the patient term “Morgellons” because it is the word that matches what I see. I am not asking you to adopt a contested diagnosis on sight. I am asking you to look, document, and treat what is treatable.

What I experience

• Crawling / biting / stinging / burning (circle)
• Visible material: fibers / specks / granules / none today (circle)
• Locations: ______________________________________________
• Sleep, work, mood impact: ________________________________

What I am asking

1. A full skin exam and wound care if sores are open.
2. To rule out ordinary infection, infestation, dermatitis, and other medical causes before the visit is filed as psychiatric only.
3. Help with itch, sleep, and pain even if we disagree about cause.
4. A follow-up plan I can read on paper.

What I have already tried

________________________________________________________________

I know the 2012 CDC-sponsored study did not find a shared pathogen with the tests used, and that 2025–2026 papers still disagree. I am not here to litigate that literature in a fifteen-minute slot. I am here because my skin and my days are not working.

Name: ______________________   Signature: ______________________