Toxicity Self-Test

Rate each of the following symptoms

based upon your 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
Nausea or vomiting   Chest congestion
Diarrhea   Asthma, bronchitis
Constipation   Shortness of breath
Bloated feeling   Difficulty breathing
Belching, passing gas   Total
Total     Mind

  Ears   Confusion
Itchy ears   Poor concentration
Earaches, ear infection   Poor coordination
Drainage from ear   Difficulty making decisions
Ringing in ears, hearing loss   Stuttering, stammering
Total   Slurred speech

  Learning disabilities
  Emotions   Total
Mood swings  
Anxiety, fear, nervousness     Mouth/Throat
Anger, irritability   Chronic coughing
Depression   Gagging, frequent need to clear throat
Total   Sore throat, hoarse

  Swollen or discolored tongue, gums, lips
  Energy/Activity   Canker sores
Fatigue, sluggishness   Total
Apathy, lethargy  
Hyperactivity     Nose
Restlessness   Stuffy nose
Total   Sinus problems

  Hay fever
  Eyes   Sneezing attacks
Watery, itchy eyes   Excessive mucus
Swollen, reddened r sticky eyelids   Total
Dark circles under eyes  
Blurred/tunnel vision     Skin
Total   Acne

  Hives, rashes, dry skin
  Head   Hair loss
Headaches   Flushing or hot flashes
Faintness   Excessive sweating
Dizziness   Total
Total     Weight

  Binge eating/drinking
  Heart   Craving certain foods
Skipped heartbeats   Excessive weight
Rapid heartbeats   Compulsive eating
Chest pain   Water retention
Total   Underweight

Pain aches in joints     Other
Arthritis   Frequent illness
Stiffness, limited movement   Frequent or urgent urination
Pain, aches in muscles   Genital itch, discharge
Feeling of weakness or tiredness   Total

Grand Total  
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