Toxicity Self Test

Rate each of the followint symptoms based upot you health profile for the past 30 days.   Point scale. 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     Digestive system     Lungs 0 1 2 3 4 Nausea or vomiting   0 1 2 3 4 Chest congestion 0 1 2 3 4 Diarrhea   0 1 2 3 4 Asthma, bronchitis 0 1 2 3 4 Constipation   0 1 2 3 4 Shortness of breath 0 1 2 3 4 Bloated feeling   0 1 2 3 4 Difficulty breathing 0 1 2 3 4 Belching, passing gas   Total 0 1 2 3 4 Heartburn   Total     Mind   0 1 2 3 4 Poor   Ears   0 1 2 3 4 Confusion 0 1 2 3 4 Itchy ears   0 1 2 3 4 Poor concentration 0 1 2 3 4 Earaches, ear infection   0 1 2 3 4 Poor coordination 0 1 2 3 4 Drainage from ear   0 1 2 3 4 Difficulty making decisions 0 1 2 3 4 Ringing in ears, hearing loss   0 1 2 3 4 Stuttering, stammering Total   0 1 2 3 4 Slurred speech   0 1 2 3 4 Learning disabilities   Emotions   Total 0 1 2 3 4 Mood swings   0 1 2 3 4 Anxiety, fear, nervousness     Mouth/Throat 0 1 2 3 4 Anger, irritability   0 1 2 3 4 Chronic coughing 0 1 2 3 4 Depression   0 1 2 3 4 Gagging, frequent need to clear throat Total   0 1 2 3 4 Sore throat, hoarse   0 1 2 3 4 Swollen or discolored tongue, gums, lips   Energy/Activity   0 1 2 3 4 Canker sores 0 1 2 3 4 Fatigue, sluggishness   Total 0 1 2 3 4 Apathy, lethargy   0 1 2 3 4 Hyperactivity     Nose 0 1 2 3 4 Restlessness   0 1 2 3 4 Stuffy nose Total   0 1 2 3 4 Sinus problems   0 1 2 3 4 Hay fever   Eyes   0 1 2 3 4 Sneezing attacks 0 1 2 3 4 Watery, itchy eyes   0 1 2 3 4 Excessive mucus 0 1 2 3 4 Swollen, reddened r sticky eyelids   Total 0 1 2 3 4 Dark circles under eyes   0 1 2 3 4 Blurred/tunnel vision     Skin Total   0 1 2 3 4 Acne   0 1 2 3 4 Hives, rashes, dry skin   Head   0 1 2 3 4 Hair loss 0 1 2 3 4 Headaches   0 1 2 3 4 Flushing or hot flashes 0 1 2 3 4 Faintness   0 1 2 3 4 Excessive sweating 0 1 2 3 4 Dizziness   Total 0 1 2 3 4 Insomnia   Total     Weight   0 1 2 3 4 Binge eating/drinking   Heart   0 1 2 3 4 Craving certain foods 0 1 2 3 4 Skipped heartbeats   0 1 2 3 4 Excessive weight 0 1 2 3 4 Rapid heartbeats   0 1 2 3 4 Compulsive eating 0 1 2 3 4 Chest pain   0 1 2 3 4 Water retention Total   0 1 2 3 4 Underweight   Total   Joints/Muscles   0 1 2 3 4 Pain aches in joints     Other 0 1 2 3 4 Arthritis   0 1 2 3 4 Frequent illness 0 1 2 3 4 Stiffness, limited movement   0 1 2 3 4 Frequent or urgent urination 0 1 2 3 4 Pain, aches in muscles   0 1 2 3 4 Genital itch, discharge 0 1 2 3 4 Feeling of weakness or tiredness   Total Total         Grand Total       Copyright® 2002 Health Key Inc. All rights reserved