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Are Toxins the Root of My Symptoms?

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Do you consume conventionally-farmed or genetically modifed vegetables and fruits?

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Yes/Seldomly

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Only In The Past

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No/Never

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Do you consume canned vegetables, fruits, or beans?

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Only In The Past

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Do you consume conventionally-raised meat, poultry, dairy, and eggs?

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Only In The Past

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Do you consume farmed or canned fish or shellfish?

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Do you consume wild-caught fish or shellfish?

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Do you consume fried foods or fast foods?

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Do you consume processed foods with food additives (e.g. emulsifiers, favor enhancers, fiber additives, gums and thickening agents, artificial or natural food dyes, preservatives or natural antioxidant preservatives)?

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Only In The Past

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Do you consume artificial sweeteners (e.g. NutraSweet, Equal, Sweet ‘N Low, Splenda, acesulfame K) or natural sweeteners (e.g. agave, stevia, monk fruit)?

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Only In The Past

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No/Never

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Do you drink well water?

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Only In The Past

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Do you drink water bottled in plastic bottles?

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Only In The Past

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Do you consume 4 or more drinks of alcohol per day, or 7 or more drinks per week for females or 14 or more drinks per week for males (1 drink = 12 oz beer, 5 oz wine, 1.5 oz liquor)?

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Do you smoke cigarettes or chew tobacco?

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Do you vape nicotine?

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No/Never

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Do you vape cannabis?

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Are you exposed to secondhand smoke or secondhand vaping?

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Do you use over-the-counter or prescription medications?

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Do you have strong or adverse reactions to anesthesia, over-the-counter or prescription medications, recreational drugs, or dietary supplements?

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Are you sensitive to or have reactions to strongly scented products (e.g. candles, body sprays, fragrances etc.)?

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Are you sensitive to or have reactions to soaps, face and body lotions, or hair care products?

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Do you use personal and body care products containing parabens or phthalates (e.g., methyl-, ethyl-, or butyl- parabens or monoethyl-, mono-2- ethylhexyl-, or diethyl- phthalates)?

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Do you use perfumes, fragrances, or body sprays?

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Do you use conventional or natural tanning products?

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Do you use nail polish or acrylic, gel, or dip powder nail products?

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Do you have mercury or silver fllings or use oral dentures, retainers, mouth guards, teeth aligners, or bleaching trays?

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Do you have implanted joint replacements or other implanted medical devices (e.g. nails, pins, screws, pumps, pacemakers, breast implants etc.)?

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Do you live or work near an agricultural area where food crops are grown?

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Do you live or work near a livestock farm raising cattle, poultry, pork, goats, or sheep?

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Do you live or work near cell phone towers, power lines, or nuclear power plant, or work with X-rays or MRI machines?

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Do you live or work near an industrial plant, gas station, water treatment plant, landfill site (garbage dump), recycling facility, or waste incinerator?

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Do you live or work in a water-damaged home or building with mold odor, visible mold patches or colonies, or suspected hidden mold in wall or floor cavities?

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Do you live or work in a poorly ventilated building?

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Do you live or work in a newly constructed or newly renovated building, or drive a new vehicle?

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Are you exposed to industrial “dusts” in your workplace?

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Are you exposed to “non-green” cleaning chemicals, sanitizers, disinfectants, or aerosol sprays at home or in your workplace (e.g. hospital, healthcare, or school settings)?

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Do you work in a workplace with high exposure to toxins such as construction, landscaping, roofer, oil/gas/mining industry, waste removal, janitor or building cleaner, automotive industry, hair or nail salon, maintenance and repair worker, heating and fuel (HVAC) industry etc.?

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Do you engage in hobbies using paints, solvents, dyes, glues, adhesives, ceramics, textiles (e.g. woodworking, painting, ceramics, pottery, sculpting, jewelry making, knitting etc.)?

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Do you walk, bike, or run on roadways?

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Do you engage in sports on artificial turf, municipal parks, or playing fields?

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