The Folate Deficiency Checklist is a tool for providers to use to identify the inherited genetic marker called MTHFR as well as conditions and medications that deplete folate levels. 

 

This form can be used to educate the patient on folate deficiency by simply asking a few questions. Many patients may not understand why they have low energy, trouble sleeping, lack of motivation, or concentration but the common link is often these inherited genetic markers which deplete folate as well as these other factors.