Are you Toxic?

0 = Never or almost never have the symptom

1 = Occasionally have it; effect is not severe

2 = Occasionally have it; effect is severe

3 = Frequently have it; effect is not severe

4 = Frequently have it; effect is severe

Select the correct answer for you.

EARS	0	1	2	3	4
5. Itchy ears
6. Ringing in ears/loss of hearing
7. Ear aches/ear infections
8. Drainage from ear

EYES	0	1	2	3	4
9. Bags or dark circles under eyes
10. Watery or itchy eyes
11. Swollen, reddened,or sticky eyelids
12. Blurred or tunnel vision (excluding near or far sightedness)

NOSE	0	1	2	3	4
13. Stuffy nose
14. Sinus congestion, sinus infection
15. Constant sneezing
16. Hay fever/allergies
17. Excess mucus formation

MOUTH/THROAT	0	1	2	3	4
18. Chronic coughing
19. Sore throat, hoarseness, loss of voice
20. Gagging, frequent need to clear throat
21. Swollen tongue, gums or lips
22. Swollen lymph nodes
23. Canker sores, mouth ulcers

HEART	0	1	2	3	4
24. Chest pain
25. Irregular or skipped heartbeat
26. Rapid or pounding heartbeat

JOINTS/MUSCLES	0	1	2	3	4
38. Pain or aches in joints or lower back
39. Stiffness or limitation of movement
40. Arthritis
41. Pain or aches in muscles

MENTAL/EMOTIONAL	0	1	2	3	4
42. Poor memory
43. Difficulty concentration
44. Mood swings
45. Depression
46. Anxiety, fear or nervousness
47. Anger, irritability, or aggressiveness
48. Insomnia

OTHER	0	1	2	3	4
64. PMS
65. Frequent colds, flus
66. Chemical or environmental sensitivities
67. Food allergies/sensitivities