Traditional Chinese Medicine Health Questionnaire

Never = 0  Sometimes = 1 Often =2

1. Do you suffer from constipation or digestive issues such as bloating or heartburn?             
2. Do you have less than one bowel movement a day?                                         
3. Do you experience brain fog, drowsiness, headaches, or fatigue in the day?               
4. Do you find it difficult to lose weight?   
5. Do you suffer with stress anxiety or depression?                           
6. Do you eat refined carbohydrates, processed or packaged foods, more than 2x a week?
7. Do you experience cravings that are difficult to control?                                       
8. Do you tend to get colds and flus easily?                                                               
9. Have you used antibiotics or over the counter drugs in the past 6 months?   
10. Does your occupation expose you to toxic chemicals on a daily basis?         
11. Do you smoke or are you exposed to secondhand smoke through a wood fireplace or other people smoking in your environment?
12. Do you have two or more mercury fillings in your mouth?                                 
13. Do you use commercial products like Febreze or other chemically laden Skin care products on a regular basis?
14. Do you use plastic containers to store or heat food or drink from plastic containers?

Total ______________

Evaluation of your Result:

Less than 5
Keep up the good work: Low Toxicity

6 to 17
Knowledge is power: Average Toxicity

More than 18
Time for purification: High Toxicity