DETOX QUESTIONNAIRE

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    Irritability
    Nervousness
    Mood swings
    Frequent crying
    Aggressive behavior
    Anxiety
    Fear
    Confusion
    Depression
    Suicidal thoughts
    TOTAL EMOTIONS
    Please enter one response per row
    Increased sweating, ear wax, oily skin
    Skin rashes
    Brown spots on hands and face
    Boils
    Skin tags
    Acne
    Eczema
    Fever blisters
    Warts
    TOTAL SKIN
    Please enter one response per row
    Increased salivation
    Mouth ulcers
    Common cold
    Sinusitis
    Sore throats
    Ear infections
    Hay fever
    Loss of smell
    Cough
    TOTAL EAR, NOSE and THROAT
    Please enter one response per row
    Hyperactivity
    Slammering when speaking
    Difficulty in concentration
    Sleep disturbance
    Difficulty in making decisions
    Headache
    Poor memory
    Poor coordination
    Compulsive behavior
    Memory loss
    TOTAL MIND and BRAIN
    Please enter one response per row
    Loose stool
    Diarrhea
    Heartburn
    Constipation
    Bloating
    Abdominal pain
    Intolerance top certain foods
    Nausea or vomiting
    Severe diarrhea with blood or mucous
    TOTAL DIGESTIVE SYSTEM
    Please enter one response per row
    Increase in urination frequency and amount
    Needing to get up in the night to pass urine
    Urinary tract infections and cystitis
    Kidney stones
    Blood in the urine
    TOTAL KIDNEY
    Please enter one response per row
    Feeling muscles aches or joint aches
    Tendinitis
    Gout
    Arthritis
    Fibromyalgia
    TOTAL JOINTS and MUSCLES
    Please enter one response per row
    Feeling of coldness
    Hypoglycemia
    Craving certain foods
    Water retention
    Obesity
    Cellulite
    TOTAL METABOLISM
    Please enter one response per row
    Please enter one response per row