BACK Toxic Screen 09 Sep, 2020 Welcome to your Toxic Screen Name Emaiil Phone Weight InformationAre you happy with your weight?YesSomewhat happyNoVery unhappyHave you always been overweight?NoSomewhatYes as an adultAll my lifeHow do you feel about your weight?ComfortableConcernedWorriedFrustratedHow have you felt about your weight in the past?Never an issueSometimes an issueOften a worryAlways an issueAre you prepared to reshape your lifestyle to achieve your health and weight goals?Don´t want to changeWill look at small changesReady to make some changesTotally committed to do whatever I need toPainful and/or lumpy breasts?NoSometimesRegularlyDebilitatingCyclical headaches?NoSometimesRegularlyDebilitatingInfertility?NoI don´t knowRegularlyDebilitatingSECTION 1Detoxification HEAD Headaches?NoSometimesRegularlyDebilitatingFaintness?NoSometimesRegularlyDebilitatingDizziness?NoSometimesRegularlyDebilitatingInsomnia?NoSometimesRegularlyDebilitatingNot at allNoSometimesRegularlyDebilitatingSome symptoms?NoSometimesRegularlyDebilitatingRegular problems?NoSometimesRegularlyDebilitatingDebilitating situation?NoSometimesRegularlyDebilitatingEYES Watery or itchy eyes?NoSometimesRegularlyDebilitatingSwollen, reddened or sticky eyelids?NoSometimesRegularlyDebilitatingBags or dark circles under eyes?NoSometimesRegularlyDebilitatingBlurred or tunnel vision?NoSometimesRegularlyDebilitatingWeight Information Are you happy with your weightYesSomewhatNoVery unhappyEARS Itchy ears?NoSometimesRegularlyDebilitatingEaraches, ear infections?NoSometimesRegularlyDebilitatingDrainage from ear?NoSometimesRegularlyDebilitatingRinging in ears, hearing loss?NoSometimesRegularlyDebilitatingAbout YouYour new question!How many times a day do you eat pasta, rice, pastries, croissants, cakes, biscuits, pizzas, bread, cereals, rolls?NoneOneTwoMore than 2NOSE Stuffy nose?NoSometimesRegularlyDebilitatingSinus problems?NoSometimesRegularlyDebilitatingHay fever?NoSometimesRegularlyDebilitatingSneezing attacks?NoSometimesRegularlyDebilitatingMouth?NoSometimesRegularlyDebilitatingMOUTHChronic coughing?NoSometimesRegularlyDebilitatingThroat?NoSometimesRegularlyDebilitatingTHROAT Gagging, frequent need to clear throat?NoSometimesRegularlyDebilitatingSore throat, hoarseness, loss of voice?NoSometimesRegularlyDebilitatingSwollen or discolored tongue, gums, lips?NoSometimesRegularlyDebilitatingCanker sores?NoSometimesRegularlyDebilitatingSKIN Acne?NoSometimesRegularlyDebilitatingHive, rashes, dry skin?NoSometimesRegularlyDebilitatingHair loss?NoSometimesRegularlyDebilitatingFull NameFlushing, hot flushes?NoSometimesRegularlyDebilitatingExcessive sweating?NoSometimesRegularlyDebilitatingHEART Chest pain?NoSometimesRegularlyDebilitatingIrregular or skipped heartbeat?NoSometimesRegularlyDebilitatingRapid or pounding heartbeat?NoSometimesRegularlyDebilitatingLUNGS Chest congestion?NoSometimesRegularlyDebilitatingAsthma, bronchitis?NoSometimesRegularlyDebilitatingShortness of breath?NoSometimesRegularlyDebilitatingDifficulty breathing?NoSometimesRegularlyDebilitatingDIGESTIVE TRACT Nausea, vomiting?NoSometimesRegularlyDebilitatingDiarrhea?NoSometimesRegularlyDebilitatingConstipation?NoSometimesRegularlyDebilitatingBloated feeling?NoSometimesRegularlyDebilitatingBelching, passing gas?NoSometimesRegularlyDebilitatingHeartburn?NoSometimesRegularlyDebilitatingIntestinal / stomach pain?NoSometimesRegularlyDebilitatingJOINTS/MUSCLE Pain or aches in joints?NoSometimesRegularlyDebilitatingArthritis?NoSometimesRegularlyDebilitatingStiffness or limitation of movement?NoSometimesRegularlyDebilitatingFeeling of weakness or tiredness?NoSometimesRegularlyDebilitatingPain or aches in muscles?NoSometimesRegularlyDebilitatingWEIGHT Binge eating/drinking?NoSometimesRegularlyDebilitatingCraving certain foods?NoSometimesRegularlyDebilitatingExcess weight?NoSometimesRegularlyDebilitatingWater retention?NoSometimesRegularlyDebilitatingUnderweight?NoSometimesRegularlyDebilitatingCompulsive eating?NoSometimesRegularlyDebilitatingENERGY/ ACTIVITY Fatigue, sluggishness?NoSometimesRegularlyDebilitatingApathy, lethargy?NoSometimesRegularlyDebilitatingHyperactivity?NoSometimesRegularlyDebilitatingRestlessness?NoSometimesRegularlyDebilitatingMIND Poor memory?NoSometimesRegularlyDebilitatingConfusion, poor comprehension?NoSometimesRegularlyDebilitatingDifficulty in making decisions?NoSometimesRegularlyDebilitatingStuttering or stammering?NoSometimesRegularlyDebilitatingSlurred speech?NoSometimesRegularlyDebilitatingLearning disabilities?NoSometimesRegularlyDebilitatingPoor concentration?NoSometimesRegularlyDebilitatingPoor physical coordination?NoSometimesRegularlyDebilitatingEMOTIONS Mood swings?NoSometimesRegularlyDebilitatingAnxiety, fear, nervousness?NoSometimesRegularlyDebilitatingAnger, irritability, aggressiveness?NoSometimesRegularlyDebilitatingDepression?NoSometimesRegularlyDebilitatingEnergy?No energyLowMediumHighOTHER Frequent illness?NoSometimesRegularlyDebilitatingFrequent or urgent urination?NoSometimesRegularlyDebilitatingGenital itch or discharge?NoSometimesRegularlyDebilitatingRegular colds and infections?NoSometimesRegularlyDebilitatingFrequent bouts of depression?NoSometimesRegularlyDebilitatingHow often do you exercise?DailyOccasionallyRarelyNeverSECTION 3 Tobacco Do you currently smoke cigarettes?DailyOccasionallyRarelyNeverCaffeine use Do you consume drinks with caffeine (coffee, tea, soda drinks)?DailyOccasionallyRarelyNeverAlcohol and Drugs Do you drink alcohol?DailyOccasionallyRarelyNeverDo you consume drugs?DailyOccasionallyRarelyNeverHormone Balance Test For Men SYMPTOM GROUP 1 Weight loss?NoSometimesRegularlyDebilitatingSECTION 2 Exercise Do you consider your exercise habits to be?ExcellentGoodFairPoorHave you always been overweight?NoSomewhatYes as an adultAll my lifeHow do you feel about your weight?ComfortableConcernedWorriedFrustratedHow have you felt about your weight in the past?Never an issueSometimes an issueOften a worryAlways an issueAre you prepared to reshape your lifestyle to achieve your health and weight goals?Don’t want to changeWill look at small changesReady to make some changesTotally committed to do whatever I need toHeightWeightADDITIONAL WEIGHT INFORMATION Are you happy with your weight?YesSomewhat happyNoVery unhappyHave you always been overweight?NoSomewhatYes as an adultAll my lifeHow old are you?Under 3030-4546-5960+HeightWeight WeightTime is Up!