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This FREE Metabolic Lifestyle Assessment is designed to aid us in assessing your potential need for a Nutrition & Lifestyle Program based upon your symptoms and current habits. The results can also used by any of your current & future health care practitioners to help them understand what you are dealing with at this time, so they can give you getter recommendations to improve your health & wellness.

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Section I: Symptoms

Rate each of the following based upon your health profile for the past 90 days.

1. DIGESTIVE

A. NAUSEA AND/OR VOMITING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. DIARRHEA

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. CONSTIPATION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. BLOATED FEELING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. BELCHING AND/OR PASSING GAS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

REQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

F. HEARTBURN

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

2. EARS

A. ITCHY EARS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. EARACHES OR EAR INFECTIONS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. DRAINAGE FROM EAR

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. RINGING IN EARS OR HEARING LOSS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

3. EMOTIONS

A. MOOD SWINGS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. ANXIETY, FEAR, OR NERVOUSNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. ANGER, IRRITABILITY

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. DEPRESSION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. SENSE OF DESPAIR

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

F. UNCARING OR DISINTERESTED

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

4. ENERGY / ACTIVITY

A. FATIGUE OR SLUGGISHNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

REQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. HYPERACTIVITY

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. RESTLESSNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. INSOMNIA

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. STARTLED AWAKE AT NIGHT

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

5. EYES

A. WATERY OR ITCHY EYES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. SWOLLEN, REDDENED, OR STICKY EYELIDS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. DARK CIRCLES UNDER EYES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. BLURRED OR TUNNEL VISION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

6. HEAD

A. HEADACHES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. FAINTNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. DIZZINESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. PRESSURE

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

7. LUNGS

A. CHEST CONGESTION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. ASTHMA OR BRONCHITIS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. SHORTNESS OF BREATH

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. DIFFICULTY BREATHING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

8. MIND

A. POOR MEMORY

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. CONFUSION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. POOR CONCENTRATION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. POOR COORDINATION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. DIFFICULTY MAKING DECISIONS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

F. STUTTERING, STAMMERING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

G. SLURRED SPEECH

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

H. LEARNING DISABILITIES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

9. MOUTH/THROAT

A. CHRONIC COUGHING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. GAGGING OR FREQUENT NEED TO CLEAR THROAT

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. SWOLLEN OR DISCOLORED TONGUE, GUMS, LIPS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. CANKER SORES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

10. NOSE

STUFFY NOSE

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

SINUS PROBLEMS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

HAY FEVER

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

SNEEZING ATTACKS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

EXCESSIVE MUCOUS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

11. SKIN

A. ACNE

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. HIVES, RASHES, OR DRY SKIN

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

REQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. HAIR LOSS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. FLUSHING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. EXCESSIVE SWEATING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

12. HEART

A. SKIPPED HEARTBEATS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. RAPID HEARTBEATS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. CHEST PAIN

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

13. JOINTS / MUSCLES

A. PAIN OR ACHES IN JOINTS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. RHEUMATOID ARTHRITIS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. OSTEOARTHRITIS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. STIFFNESS OR LIMITED MOVEMENT

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. PAIN OR ACHES IN MUSCLES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

F. RECURRENT BACK ACHES

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

G. FEELING OF WEAKNESS OR TIREDNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

14. WEIGHT

A. BINGE EATING OR DRINKING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. CRAVING CERTAIN FOODS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. EXCESSIVE WEIGHT

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. COMPULSIVE EATING

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

E. WATER RETENTION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

F. UNDERWEIGHT

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

15. OTHER

A. FREQUENT ILLNESS

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

B. FREQUENT OR URGENT URINATION

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

C. LEAKY BLADDER

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

D. GENITAL ITCH, DISCHARGE

RARELY OR NEVER EXPERIENCE THE SYMPTOM

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

OCCASIONALLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS NOT SEVERE

FREQUENTLY EXPERIENCE THE SYMPTOM, EFFECT IS SEVERE

Section II: Risk of Exposure

Rate each of the following situations based upon your environmental profile for the past 120 days.

18 A. DO YOU HAVE A WATER PURIFICATION SYSTEM IN YOUR HOME?

YES

18 B. DO YOU HAVE ANY INDOOR PETS?

YES

18 C. DO YOU HAVE AN AIR PURIFICATION SYSTEM IN YOUR HOME?

YES

18 D. ARE YOU A DENTIST, PAINTER, FARM WORKER, OR CONSTRUCTION WORKER?

YES