Toxicity Questionnaire

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Interested in knowing your degree of toxicity? Just answer the following questions, add the points and turn over to the next page to read about your result. When answering the questions you should ask yourself if the symptoms mentioned occurred in the last few months.

What is YOUR degree of toxicity? Take the toxicity quiz to find out!

Created by: Marcie of Chiropractic Healing Center of NJ
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Are you ready for...
Our "When Will I Die" Quiz?

  1. What is your age?
  2. What is your gender?
  1. Do you feel irritable or nervous?
  2. Do you suffer from mood swings or crying spells?
  3. Do you feel anxious or have fears without justified reasons?
  4. Are you experiencing a decrease in memory or concentration?
  5. Do you suffer from headaches?
  6. Do you have disturbed and restless sleep?
  7. Do you suffer from skin problems such as increased sweating, skin rashes, acne or eczema?
  8. Are you having excessive salivation or mucous production?
  9. Do you suffer from sinusitis or ear infections?
  10. Do you suffer from constipation, diarrhea or bloating?
  11. Do you suffer from urinary tract infections?
  12. Do you suffer from muscle or joint aches?
  13. Do you have cravings for certain foods (bread, cheese, sweets)?
  14. Do you feel stressed or exhausted?
  15. Do you drink alcoholic beverages?
  16. Do you eat in fat food restaurants?
  17. Do you tend to eat unbalanced diets?
  18. Do you suffer from arthritis?
  19. Do you have problems with water retention?
  20. Do you have any food intolerances?
  21. Do you smoke?
  22. Do you suffer from any kind of allergies?
  23. Have you been diagnosed with fibromyalgia?
  24. Do you tend to gain weight easily?
  25. Do you suffer from cellulite or obesity?
  26. Are you exposed to toxic substances at work?

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