Toxicity Assessment Test

Name *

First Name

Last Name

1. *

I wake up feeling tired, dull, heavy, always needing caffeine to get going

Never

Sometimes

Always

2. *

I feel mentally dull, lack enthusiasm, and am easily fatigued

Never

Sometimes

Always

3. *

Every morning my tongue is coated and my breath smells

Never

Sometimes

Always

4. *

I often experience food as tasteless and have a very small appetite

Never

Sometimes

Always

5. *

I regularly suffer a feeling of heaviness and indigestion shortly after eating

Never

Sometimes

Always

6. *

My stools are heavy, sink and smell extremely unpleasant

Never

Sometimes

Always

7. *

I have a lot of mucus and get many colds throughout the year

Never

Sometimes

Always

8. *

I often feel a sense of heaviness in my body, as though I have a blockage somewhere

Never

Sometimes

Always

9. *

I tend to get constipation

Never

Sometimes

Always

10. *

I often feel the need to spit

Never

Sometimes

Always

11. *

I tend to put on weight that I cannot shift

Never

Sometimes

Always