The introduction of natural gas drilling with high-volume hydraulic fracturing to Pennsylvania and neighboring states since 2004 has been accompanied by numerous reports of varied symptoms and illnesses by those living near these operations. Pollutants with established toxic effects in humans may be introduced into the environment at various points during gas extraction and processing. Some community residents, as well as employees of the natural gas industry, believe that their health has deteriorated as a result of these operations and have sought medical care from local practitioners, who may have limited access to immediate toxicological consultations. This article reviews taking an environmental exposure history in the context of natural gas activities, underscoring the importance of thorough and guided history-taking in the discovery of environmental exposure clusters. It also highlights the critical need for funding, research, and peer-reviewed studies to help generate the body of evidence that is needed by practitioners.