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General Toxic State

09 Dec, 2019

Welcome to your General Toxic State

Name

Email

Phone

What is your body type?

Lean

Average

Overweight

Obese

How often do you walk for 10 minutes or more.

Everyday

4-5 days/week

1-3 days/week

Never

How often do you workout for 20 minutes or more?

Everyday

4-5 days/week

1-3 days/week

Never

How many processed foods do you eat a day

(foods pre-prepared, from a tin with additives,, packaged or man made)?

1 or less

2-4 servings

5-9 servings

10 or more servings

How would you rate your skin?

Mostly clear

Occasional blemishes

Frequent breakouts

Constantly suffer from skin conditions

How often do you drink alcohol?

Never or 1 glass a week

2-3 times/week

4-5 times/week

Daily

How often do you have a bowel movement?

Twice or more a day

Once a day or every other day

Less then 3 times/week

Less than once a week

How much water do you drink per day?

8-12 glasses

5-7 glasses

2-4 glasses

1 or less

When do you feel tired?

Only at bedtime

Occasionally late in the afternoon

Most of the day especially mornings

Generally tired

Time is Up!