Toxicity Self Test

Rate each of the following symptoms based upon your health profile for the past 30 days:

0 - never or almost never have the symptom
1 - occasionally have it, but the effect is not severe
2 - occasionally have it and the effect is severe
3 - frequently have it, but the effect is not severe
4 - frequently have it and the effect is severe

Category 1 - Digestive _____ Nausea or vomiting _____ Diarrhea _____ Constipation _____ Bloated feeling _____ Belching, passing gas _____ Heartburn _____ Total points	Category 2 - Ears _____ Itchy ears _____ Earaches, ear infections _____ Drainage from ear _____ Ringing in ears; hearing loss _____ Total points
Category 3 - Emotions _____ Mood Swings _____ Anxiety, fear, nervousness _____ Anger, irritability _____ Depression _____ Total points	Category 4 - Energy/Activity _____ Fatigue, sluggishness _____ Apathy, lethargy _____ Hyperactivity _____ Restlessness _____ Total points
Category 5 - Eyes _____ Watery, itchy eyes _____ Swollen, reddened eyelids _____ Dark circles under eyes _____ Blurred/tunnel vision _____ Total points	Category 6 - Head _____ Headaches _____ Faintness _____ Dizziness _____ Insomnia _____ Total points
Category 7 - Lungs _____ Chest congestion _____ Asthma, bronchitis _____ Shortness of breath _____ Difficulty breathing _____ Total points	Category 8 - Mind _____ Poor memory _____ Confusion _____ Poor concentration _____ Poor coordination _____ Difficulty making decisions _____ Stuttering, stammering _____ Slurred speech _____ Learning disabilities _____ Total points
Category 9 - Mouth/Throat _____ Chronic coughing _____ Gagging/need to clear throat _____ Sore throat, hoarse _____ Swollen or discolored tongue,gums, or lips _____ Canker sores _____ Total points	Category 10 - Nose _____ Stuffy nose _____ Sinus problems _____ Hay fever _____ Sneezing attacks _____ Excessive mucus _____ Total points
Category 11 - Skin _____ Acne _____ Hives, rashes, dry skin _____ Hair loss _____ Flushing or hot flashes _____ Excessive sweating _____ Total points _____ Grand total points

How to interpret your results:

Add all of the category totals. If your test score was 15 or more, your body is experiencing toxicity and it is having a negative effect on how you feel on a daily basis. One of my detoxification programs would help you tremendously. Feel free to bring this completed form with you when you come in for a consultation.

To help you identify the areas of your body experiencing the greatest toxicity, notice the categories that have a total score of 3 or more. You can find more information about toxicity in the related article on our Health Issues page.

11 Pointe Circle, Greenville, SC 29615 (864) 235-6788

Toxicity Self Test

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