Detoxification Questionnaire

Answer the questions below and give yourself the following points for each response:

0= Never have this symptom
1= occasionally have it
2= occasionally have it, effect is severe
3= frequently have it

  • Do you feel tired, lethargic or sluggish upon waking and even throughout the day?
  • Do you have difficulty concentrating or have slow or “foggy” thinking?
  • Do you feel depressed or have mood changes (unexplained aggression or emotional outbursts)?
  • Do you get more than one or two colds per year?
  • Do you get post-nasal drip, congestion, or a stuffy nose or sinuses upon waking or throughout the day?
  • Do you have bad breath, a coated tongue, or a bitter or metallic taste in your mouth?
  • Do you experience increased sweating or have a strong body odour?
  • Do you have strong smelling urine?
  • Do you have trouble sleeping or feel unrefreshed upon waking?
  • Do you have sore muscles or joints for no apparent reason?
  • Are your nails weak, soft or brittle?
  • Do you have dark circles under your eyes?
  • Do you have digestive problems such as bloating, gas or heartburn?
  • Do you have less than one bowel movement per day?
  • Are you sensitive to perfume, foods or chemicals?
  • Do you have allergies to various household products, dust, and moulds?
  • Do you have eczema, dry skin, acne, skin tags or rashes?
  • Do you gain weight easily?
  • Do you have food cravings, especially for carbohydrate-rich foods and/or sweets?
  • Do you feel ill after you consume even small amounts of alcohol?
  • Do you experience water retention in your hands, feet, breasts or face?
  • Do you suffer from genital itching or discharge?

 

Score: ________

If you answer yes to the following questions, add the number of points indicated to your total score above.

  • Are you on any hormone replacement therapy such as estrogen, thyroid or oral contraceptives? (3)
  • Have you taken antibiotics for more than a month at a time, or taken antibiotics more than two times in the past year? (3)
  • Do you have a personal history of:
    Chronic fatigue syndrome (5)
    Multiple chemical sensitivity (5)
    Fibromyalgia (5)
    Parkinson’s Disease (5)
    Alcohol, chemical or tobacco dependence (5)
    Cancer (5)
    Autoimmune Disease (5)

 

Total Score: ________

 

Your Score:

Under 20: You must already know the benefits of detoxification and a healthy lifestyle. For additional guidance and different ways to detoxify your body, ask a naturopathic doctor. Keep up the good work!

20-50: At this score, you’re probably not feeling your best. You don’t have to put up with the annoying symptoms that are beginning to appear in your life. You will feel invigorated and re-energized by completing a detox. Go for it!

Over 50: According to this assessment, all signs indicate that you could be heading towards a health crisis. Detoxification is a critical part of your path to healing and will make a significant change in your well being. Make an appointment to consult with your naturopathic doctor today. You’ll be glad you did.

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