Toxicity Self Assessment Test

See if you need to take a Detoxification Program. Simply tick the appropriate score to the questions below (0 - none; 1 - sometimes; 2 - usually):

• Required

Title DR MISS MR MRS MS

First Name

Last Name

Email Address

1. Bloating, Gas, Indigestion or Heartburn 0 1 2

2. Body Odour, Bad Breath, a coated Tongue or a bitter metallic taste in my mouth? 0 1 2

3. Food Allergies? 0 1 2

4. Depression, Anxiety or Stress? 0 1 2

5. Easy weight gain? 0 1 2

6. Fluid retention? 0 1 2

7. Eczema, acne, psoriasis or other Skin problems? 0 1 2

8. Fatigue, Lethargy or Sluggishness? 0 1 2

9. Food Cravings? 0 1 2

10. Constipation (less than one bowel movement per day)? 0 1 2

11. Mood swings? 0 1 2

12. More than one or two colds a year? 0 1 2

13. Nasal congestion or sinus? 0 1 2

14. Poor Memory/Concentration? 0 1 2

15. Sensitivity to Odours, Foods or Chemicals? 0 1 2

16. Sleeping troubles or feeling Tired when I wake up? 0 1 2

17. Lethargic or continually Tired? 0 1 2

18. Sore Muscles or Joints? 0 1 2

19. Strong smelling Urine? 0 1 2

20. Cellulite? 0 1 2

21. Headaches or Migraines? 0 1 2

22. Notice signs of Premature Ageing? 0 1 2

Prove you're not a robot *

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