Toxicity Questionnaire

What types of toxins might be affecting you?

Not only does what we put into our bodies make a difference on our mood, energy and overall health, but environmental exposure to various pollutants also play a big role.  You never know what’s being absorbed by our largest organ–our skin–and from what we inhale on a daily basis.

This Toxicity Questionnaire will walk you through many questions that reflect how you may be responding to these outside stressors.

Toxicity Questionnaire

  • Choose the best corresponding number for the questions below. 0 = Rarely or never experience the symptom 1 = Occasionally experience the symptom - Effect is not severe 2 = Occasionally experience the symptom - effect is severe 3 = Frequently experience the symptom - effect is not severe 4 = Frequently experience the symptom - effect is severe
  • DIGESTION

  • EARS

  • EMOTIONS

  • ENERGY / ACTIVITY

  • EYES

  • HEAD

  • LUNGS

  • MIND

  • MOUTH / THROAT

  • SINUS

  • SKIN

  • HEART

  • JOINTS / MUSCLES

  • WEIGHT

  • OTHER

  • SECTION 2: Risk of Exposure

  • GRAND TOTAL

 

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