***Disclaimer*** For your privacy, we only take into account the total score and do not see your answers to individual questions. 

Name *
Name
Nutrition - 1. Do you food shop less frequently than every four days?

2. Do you eat more packaged (frozen or canned) fruits and vegetables than fresh? *
3. Do you eat more cooked vegetables than raw?
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4. Do you eat vegetables with less than two meals daily? *
5. Do you buy more non-organic vegetables than organic vegetables? 
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6. Do you use a microwave oven? *
7. Do you eat quick cook grains such as Rice-aroni, Quaker Oats or Minute rice more often than slow cooked organic whole grains? *
8. Do you eat white bread more often than whole grain breads? *
9. Do you drink pasteurized/homogenized milk, or eat cheeses frequently? 
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10. Do you eat non-organic yogurts that are low fat, presweetened or have fruit added? *
11. Do you eat typical store bought eggs from cage raised chickens (as apposed to free range, grain fed eggs)? *
12. Do you eat red meat more than once every four days? *
13. Do you commonly eat meats (beef, chicken, turkey) from sources other than a free-range and hormone-free source? *
14. Do you eat canned fish more frequently than fresh fish? *
15. Do you use commercial salad dressings? *
16. Do you use Mayonnaise or products containing hydrogenated oils? *
17. Do you eat nuts and/or seeds that are roasted and/or salted? *
18. Do you use white table sugar as a sweetener? *
19. Do you use artificial sweeteners such as Sweet-n-Low, Equal or Nurtasweet? *
20. Do you use standard white table salt? ___ *
21. Do you eat frozen dinners or other highly processed foods more than three times a week? *
22. Do you eat from fast food restaurants like McDonald’s, Arbey’s, Wendy’s, etc...? *
23. Do you eat from vending machines? *
24. Do you drink tap water? *
25. Do you eat some form of store bought dessert, such as ice cream, cookies, donuts, cakes or pies after dinner most nights? *
Stress - 1. Do you eat more or less when stressed than when not stressed? *
2. Do you worry over job, income or money problems?
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3. Are any of your relationships consistently causing you stress?
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4. Do you often feel anxious?
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5. Do you often feel upset when things go wrong or feel that things go wrong often? *
6. Do you lash out at others? *
7. Do you feel your sex drive is lower than normal for you? *
8. Do you feel stressed due to lack of intimacy in one or more relationships? *
9. Have you had reduced contact with friends (feeling antisocial) or an increase in contact because you feel you need to vent your frustrations or stresses to others? *
10. Do you feel isolated or suffer from loneliness? *
11. Do you take any form of medication prescribed by a physician directly or indirectly related to stress in your life or a psychological disorder? *
12. Do you lose more than two days of work a year due to illness? *
Circadian Health - 1. Do you live in the same time zone you were born in?
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2. Do you travel across time zones more than once a month? *
3. Do you wake up feeling un-rested and in need of more sleep? *
4. Do you commonly go to bed after 11:00 PM?
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5. Are the times you have bowel movements consistent and predictable on a daily basis?
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6. Do you suffer from reduced memory since moving to a new time zone or since traveling across time zones? *
7. Has your sense of hunger changed from being hungry at breakfast (upon rising), lunch (mid-day) and dinner times (sunset) since moving to a new time zone or traveling across time zones frequently (> 1 x Mo.)? *
8. Do you wake up at night between 1:00 am and 4:00 am and have a hard time falling back to sleep? *
9. Do you tend to have a hard time staying awake in the afternoon after eating lunch? *
10. Does your work require you to stay up late at night (passed 1am). *
Eating - 1. Do you frequently skip meals?
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2. Do you typically go more than four hours without eating? 
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3. Do you sometimes skip breakfast? 
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4. Do you avoid fats when eating? *
5. Do you frequently eat carbohydrates (i.e. breads, bagels, cookies, pasta, fruit, cereals, muffins, crackers, chocolate, or candy) by themselves? 
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6. Do you get hungry or crave sweets within two hours after eating a meal? 
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7. Do you use caffeine and/or sugar containing drinks (i.e. coffee, tea, sodas, fruit juices with sucrose, corn syrup or added sugar)? 
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8. Have you tried diets to lose weight? *
9. Do you have difficulty burning fat around your belly, hips or thighs even with regular exercise? *
10. Do you eat your largest meal at night? *
Digestive System Health - 1. Do you experience lower abdominal bloating? *
2. Do you frequently have loose stools or diarrhea? 
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3. Do you experience constipation or stools that are compact/hard to pass? 
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4. Do you find that you often burp/belch after meals?
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5. Do you frequently have gas?
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6. Do you crave certain foods, such as bread, chocolate, certain fruit, and red meat, if you have not eaten them in a day or two? 
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7. Do you have a poor appetite and/or feel worse after eating? 
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8. Do you have an excessive appetite and/or sweet cravings? 
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9. Do you frequently (more than twice a week) experience abdominal pain, cramps or general abdominal discomfort? *
10. Do you have indigestion, heartburn or upset stomach? *
11. Do you get a headache after eating? *
Fungus & Parasite 1. Have you ever been given general anesthesia? *
2. Have you ever taken antibiotics?
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3. Have you been or are you being treated for any condition requiring that you take medical drugs? *
4. In general, are your bowel movements loose, hard or foul smelling? *
5. Would you consider your life to be: *
6. Do you currently suffer from any digestive disorder or frequently have pain in the region above or below the navel? *
7. Do you have mercury amalgam fillings in your mouth? *
8. Do you have two different kinds of metal in your mouth; i.e., gold and silver or mercury amalgam and gold or silver? *
9. Do you experience itching in the ears, nose or rectum area? *
10. Do you have or have you had dandruff in the past year? *
11. Do you regularly eat or drink products containing sugar, white flour, processed dairy products? *
12. Do you crave sugar, fruit or milk if you don’t have either of these items for more than three days? *
13. Do you find that regardless of how much you eat you get hungry quickly? *
Detoxification System Health - 1. Are your eyes sensitive to bright light?
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2. Do you suffer from irritability and have difficulty relaxing? *
3. Do you often feel fatigued and sluggish? *
4. Do you suffer from frequent headaches? *
5. Do you have dark circles and/or puffiness under eyes? 
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6. Are you sensitive to perfumes, paint fumes, traffic fumes, detergents or cigarette smoke? 
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7. Have you been unable to lose cellulite with diet and/or exercise? *
8. Are you currently, or have you in the past, been frequently exposed to industrial or agricultural chemicals, such as solvents, cleaning fluids, paint fumes, plant sprays and fertilizers? 
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9. Do you experience mental sluggishness, poor memory or poor concentration? *
10. Do you suffer from skin reactions such as rashes, itching or burning, for which the cause is unknown? *