Integrative Health Practitioner Toxicity Quiz Name First Last Email to get results Date Month Day Year To complete the toxicity questionnaire and find your personal results score, simply fill in the blank ___ with a 0, 1, 2, or 3 depending on your typical symptoms. 0 = Never feel this symptom 1 = Feel this symptom 1-2 times per month 2 = Feel this symptom weekly 3 = Feel this symptom dailyHeadHeadaches/MigrainesPlease enter a number from 0 to 3.Dizziness/FaintnessPlease enter a number from 0 to 3.Neck tensionPlease enter a number from 0 to 3.Cloudy headPlease enter a number from 0 to 3.SinusNose blowingPlease enter a number from 0 to 3.SneezingPlease enter a number from 0 to 3.Allergies (seasonal or daily)Please enter a number from 0 to 3.MucusPlease enter a number from 0 to 3.Nasal congestion (stuffy nose)Please enter a number from 0 to 3.EyesDark circles under eyesPlease enter a number from 0 to 3.Bags under eyesPlease enter a number from 0 to 3.Itchy eyesPlease enter a number from 0 to 3.Discharge or watery eyesPlease enter a number from 0 to 3.Blurred visionPlease enter a number from 0 to 3.Crusted eyes upon wakingPlease enter a number from 0 to 3.EarsItchy earsPlease enter a number from 0 to 3.Discharge or drainage from earsPlease enter a number from 0 to 3.Ringing in ears, tinnitusPlease enter a number from 0 to 3.Excessive wax build upPlease enter a number from 0 to 3.Blocked or muffled hearingPlease enter a number from 0 to 3.TeethPain in gums or teethPlease enter a number from 0 to 3.Bleeding gumsPlease enter a number from 0 to 3.Silver fillings (Score with a 3 if you have any metal fillings)Please enter a number from 0 to 3.MouthCanker soresPlease enter a number from 0 to 3.Cold sores (herpes virus)Please enter a number from 0 to 3.Cracking on lipsPlease enter a number from 0 to 3.Discolored lipsPlease enter a number from 0 to 3.White film on lips upon waking or after eatingPlease enter a number from 0 to 3.TongueRed dots on tonguePlease enter a number from 0 to 3.Sides of tongue have dents (“scalloping”)Please enter a number from 0 to 3.White, yellow, or brown coating on tonguePlease enter a number from 0 to 3.Cracks or lines on tonguePlease enter a number from 0 to 3.GlandsSwollen lymph nodes (neck, armpits, or groin)Please enter a number from 0 to 3.Difficulty swallowingPlease enter a number from 0 to 3.Loss of voicePlease enter a number from 0 to 3.Swollen ankles or wrists/hands/fingersPlease enter a number from 0 to 3.BreathingChest tensionPlease enter a number from 0 to 3.Inability to get enough air inPlease enter a number from 0 to 3.Chest congestionPlease enter a number from 0 to 3.Chronic coughPlease enter a number from 0 to 3.Clear throat a lotPlease enter a number from 0 to 3.Voice hoarsenessPlease enter a number from 0 to 3.WeightDifficulty losing weightPlease enter a number from 0 to 3.Gain weight easilyPlease enter a number from 0 to 3.Feel swollen or puffyPlease enter a number from 0 to 3.Retain waterPlease enter a number from 0 to 3.Binge or compulsive eatingPlease enter a number from 0 to 3.Joints/Muscles Pain in JointsPlease enter a number from 0 to 3.Muscle stiffnessPlease enter a number from 0 to 3.Limited range of motionPlease enter a number from 0 to 3.Muscle weakness/Loss of strengthPlease enter a number from 0 to 3.ArthritisPlease enter a number from 0 to 3.SkinAcnePlease enter a number from 0 to 3.Hair lossPlease enter a number from 0 to 3.Flushing/Hot flashesPlease enter a number from 0 to 3.Dry, flaky skinPlease enter a number from 0 to 3.Excessive sweatingPlease enter a number from 0 to 3.Hives or itchinessPlease enter a number from 0 to 3.Psoriasis, eczema, ringworm or skin rashesPlease enter a number from 0 to 3.SleepInability to fall asleepPlease enter a number from 0 to 3.Can’t stay asleep/ Wake up frequentlyPlease enter a number from 0 to 3.NightmaresPlease enter a number from 0 to 3.Heart racing at nightPlease enter a number from 0 to 3.Night sweatsPlease enter a number from 0 to 3.EnergyTired upon wakingPlease enter a number from 0 to 3.Daytime or afternoon fatiguePlease enter a number from 0 to 3.General lack of energyPlease enter a number from 0 to 3.ApathyPlease enter a number from 0 to 3.Lack of ambition or drivePlease enter a number from 0 to 3.Hyperactivity (can’t sit still – have to always be doing something)Please enter a number from 0 to 3.Restlessness (feel uncomfortable with quiet)Please enter a number from 0 to 3.Tap feet or shake leg or hands when seatedPlease enter a number from 0 to 3.Decreased libido or sexual functionPlease enter a number from 0 to 3.DigestionGet tired after meals (esp. lunch)Please enter a number from 0 to 3.BloatingPlease enter a number from 0 to 3.GasPlease enter a number from 0 to 3.Belching/BurpingPlease enter a number from 0 to 3.Heartburn or indigestionPlease enter a number from 0 to 3.DiarrheaPlease enter a number from 0 to 3.ConstipationPlease enter a number from 0 to 3.Stomach or intestinal painPlease enter a number from 0 to 3.Nausea or vomitingPlease enter a number from 0 to 3.Stomach sticks out more as day progressesPlease enter a number from 0 to 3.MindLack of concentrationPlease enter a number from 0 to 3.Easily distracted or lose train of thoughtPlease enter a number from 0 to 3.Difficulty making decisionsPlease enter a number from 0 to 3.Brain fogPlease enter a number from 0 to 3.Stuttering or difficulty putting together sentencesPlease enter a number from 0 to 3.Uncoordinated or drop thingsPlease enter a number from 0 to 3.ADD/ADHD or learning disabilitiesPlease enter a number from 0 to 3.EmotionsAnxietyPlease enter a number from 0 to 3.OverwhelmPlease enter a number from 0 to 3.IrritabilityPlease enter a number from 0 to 3.Anger or ragePlease enter a number from 0 to 3.Dark thoughtsPlease enter a number from 0 to 3.Sad for no reasonPlease enter a number from 0 to 3.Mood swingsPlease enter a number from 0 to 3.DepressedPlease enter a number from 0 to 3.High-strungPlease enter a number from 0 to 3.Seasonal Affective Disorder (SAD)Please enter a number from 0 to 3.Immunity (Score each question below with 10 points if you answered yes) Frequent colds (more than 2-3 illnesses a year)Please enter a number from 0 to 10.Allergies (environmental or non-fatal food sensitivities)Please enter a number from 0 to 10.Pneumonia (Score with a 10 if yes within the last 12 months)Please enter a number from 0 to 10.Diagnosed disease (Score with a 10 if you have a diagnosed disease)Please enter a number from 0 to 10.Unexplained illness (Score with a 10 for an undiagnosed disease)Please enter a number from 0 to 10.ResultsHiddenScoreBased on your score there are 3 Stages that you may fall into:Stage 1: 0-9 PointsCongratulations - it looks like you’re doing great! You appear to be well and it seems like you have your health under control. Just make sure you are not filling up your “rain barrel” with continued stress, lack of sleep, poor eating, etc. My recommendation in terms of detoxification at this point is only a seasonal 7-day detox to keep up with and remove the continual accumulation of toxins. Do also try to incorporate a healthy daily routine as shared later in this book in order to stay well and balanced.Stage 2: 10-19 PointsIt looks like you’re doing pretty well, but you’re starting to see the effects of hidden toxicities expressing themselves on the outside as symptoms. It’s also at this point that you may be moving towards a dis- ease state unless you begin to Empty Your Rain BarrelTM. A formal 7, 14, or 21-day detox is advised and then seasonal detoxes after that to maintain optimal health and balance. I also highly recommend incorporating the daily healthy living routines shared later in the DESTRESS ProtocolTM.Stage 3: 20+ PointsYour body is now showing signs of toxic overload and total body burden. Most likely, you are feeling the effects of this toxicity in your daily life in terms of inflammation, lowered vitality, lowered mood, and less overall “get up and go.” A 21-day detox is recommended followed by a seasonal 7, 14, or 21-day detoxes to decrease toxic accumulation until you reach a score of 10 points or less. At that point you can simply drop down to one 7-day detox seasonally/quarterly. This is also the time to pay special attention to each step in the DESTRESS ProtocolTM coming up soon.Each time you complete a 7, 14, or 21-day detox please retake this RBE Toxicity Quiz to see how your score has decreased. And remember, my total toxicity score on this test used to be well over 100 pts! Now, it remains below 10 points and I want to show you how to do the same.