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New Turpentine Cleanse Survey
This form was created to track your daily experience while on the Candida Clearing Cleanse
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* Indicates required question
Email
*
Your email
Name
*
Quinn
Sara!
Shellie
Inok
Kim
Phoenix
Heath
Riley
Frankie
Rick
Shyann
Other:
Date being Referenced
*
MM
/
DD
/
YYYY
Week and Day of Cleanse:
*
Choose
Weed 1, Day 1 (Monday 21st)
Week 1, Day 2 (Tuesday 22nd)
Week 1, Day 3 (Wednesday 23rd)
Week 1, Day 4 (Thursday 24th)
Week 1, Day 5 (Friday 25th)
Week 1, Day 6 ( Saturday 26th)
Week 1, Day 7 (Sunday 27th)
Week 2, Day 1 (Monday 28th)
Week 2, Day 2 (Tuesday 29th)
Week 2, Day 3 (Wednesday 30th)
Week 2, Day 4 (Thursday 31st)
Week 2, Day 5 (Friday 1st)
Week 2, Day 6 (Saturday 2nd)
Week 2, Day 7 (Sunday 3rd)
Week 3, Day 1 (Monday 4th)
Week 3, Day 2 (Tuesday 5th)
Week 3, Day 3 (Wednesday 6th)
Week 3, Day 4 (Thursday 7th)
Week 3, Day 5 (Friday 8th)
Week 3, Day 6 (Saturday 9th)
Week 3, Day 7 (Sunday 10th)
Week 4, Day 1 (Monday 11th)
Week 4, Day 2 (Tuesday 12th)
Week 4, Day 3 (Wednesday 13th)
Week 4, Day 4 (Thursday 14th)
Week 4, Day 5 (Friday 15th)
Week 4, Day 6 (Saturday 16th)
Week 4, Day 7 (Sunday 17th)
Week 5, Day 1 (Monday 18th)
Week 5, Day 2 (Tuesday 19th)
Week 5, Day 3 (Wednesday 20th)
Week 5, Day 4 (Thursday 21st)
Week 5, Day 5 (Friday 22nd)
Week 5, Day 6 (Saturday 23rd)
Week 5, Day 7 (Sunday 24th)
Week 6, Day 1 (Monday 25th)
Week 6, Day 2 (Tuesday 26th)
Week 6, Day 3 (Wednesday 27th)
Week 6, Day 4 (Thursday 28th)
Week 6, Day 5 (Friday 29th)
Week 6, Day 6 (Saturday 30th)
Week 6, Day 7 (Sunday 1st)
Week 7, Day 1 (Monday 2nd)
Week 7, Day 2 (Tuesday 3rd)
Week 7, Day 3 (Wednesday 4th)
Week 7, Day 4 (Thursday 5th)
Week 7, Day 5 (Friday 6th)
Week 7, Day 6 (Saturday 7th)
Week 7, Day 7 (Sunday 8th)
Dosage of Turpentine & Sugar Taken (ie: 140 drops on 3 cubes)
*
Choose
Standard - 140 drops / 3 sugar cubes (1 teaspoon)
Half - 70 drops/ 2 sugar cubes (1/2 teaspoon)
Double - 280 drops / 6 sugar cubes (2 teaspoons)
N/A Day off
Rising (AM) Urine Ph Results
*
Choose
5.0
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6.0
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
7.0
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
8.0
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
9.0
I don't have this information
Rising Urine Color
*
Choose
Clear/ No color
Light Lemon Yellow
Light Amber Gold (Dark Tint)
Medium Pale Ale
Medium Amber Gold (Dark Tint)
Dark Amber Gold (Dark Tint)
Dark Guinness (Very Deep Tint)
Does your rising urine have a strong odor?
Yes
No
Clear selection
Did your rising saliva test positive for Candida overgrowth?
Yes
No
I can't tell
Clear selection
Rising Saliva Test Results - With 1 being the least and 5 being the most how much candida was showing up in your saliva test?
*
No trace of Candida - Floats on top
1 - very little candida
2 - some candida
3 - fair amount of candida
4 - large amount of candida
5 - entire glass cloudy
Did your Rising saliva test have more or less candida than yesterday?
More candida
Less Candida
Same amount
Clear selection
Did you do a tongue scrapping after your rising saliva test?
*
Yes
No
PM Urine Ph Results
*
Choose
5.0
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6.0
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
7.0
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
8.0
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
9.0
I don't have this information
PM Urine Color
*
Choose
Clear/ No color
Light Lemon Yellow
Light Amber Gold (Dark Tint)
Medium Pale Ale
Medium Amber Gold (Dark Tint)
Dark Amber Gold (Dark Tint)
Dark Guinness (Very Deep Tint)
Does your PM urine have a strong odor?
Yes
No
Clear selection
Did your PM saliva test positive for Candida overgrowth?
Yes
No
I can't tell
Clear selection
PM Saliva Test Results - With 1 being the least and 5 being the most how much candida was showing up in your saliva test?
*
1 - very little candida
2 - some candida
3 - fair amount of candida
4 - large amount of candida
5 - entire glass cloudy
No trace of Candida - Floats on top
Did your PM saliva test have more or less candida than yesterday?
More candida
Less Candida
Same amount
Clear selection
Did you do a tongue scrapping after your PM saliva test?
*
Yes
No
Estimate how many ounces of water you drink each day
*
Choose
0 - 8 OZ (1 cup)
8 - 16 OZ (2 cups)
16 - 24 OZ (3 cups)
24 - 32 OZ (4 cups)
32 - 40 OZ (5 cups)
40 - 48 OZ (6 cups)
48 - 56 OZ (7 cups)
56 - 64 OZ (8 cups)
64 - 72 OZ (9 cups)
72 - 80 OZ (10 cups)
80 - 88 OZ (11 cups)
88 - 96 OZ (12 cups)
96 - 104 OZ (13 cups)
104 - 112 OZ (14 cups)
Please list everything you ate today:
*
Fruit Smoothie (Any Variety)
Green Juice (Alone or in something else)
Coffee
Tea
Raw Fruits
Cooked Fruits
Raw Veggies
Cooked Veggies
Eggs
Quinoa
Potatoes
Rice
Wild Plants/Herbs
Other:
Required
If you deviated from the prescribed diet please select in what area:
Meat
Dairy
Wheat
Processed Foods (anything from a package)
Non fruit sugars
Dried Fruits
Nuts
Olive oil
Avocado
Seeds
Beans
Alcohol
Soda, Energy Drinks, Other carbonated beverages
Other:
Did you adhere strictly to the prescribed diet?
*
Yes
No
Overall, do you feel better or worse than the day before?
Better
Worse
No significant change
Clear selection
Overall, did you feel better before the cleanse or currently?
Before cleanse
Currently
Feel the same before and now
Clear selection
Have you experience any of the following symptoms?
*
None
Tiredness
Moodiness
Dizziness
Itchiness
Headaches
Earaches
Muscle Aches
Stomach aches
Diarrhea
Chest pain
Enhanced energy
Enhanced mental clarity
Brain Fog
Constipation
Confusion or Frustration
Excessively strong feelings or emotions
Excessive sweating / Hot flashes
Excess Burping
Excess farting
Reduced mosquito bites
Feelings of dehydration
Low Motivation to accomplish tasks
Sweat smells like bread, beer, or yeast
Lack of appetite
Increased appetite
Other cravings
Other:
Required
Describe any symptoms you have experienced in detail:
Your answer
How were your energy levels throughout the day?
*
Choose
High Physical and mental energy all day
Low Physical and mental energy all day
Medium Physical and mental energy all day
High energy either in the morning or the night but not all day
Low energy either in the morning or night but not all day
No changes in engery
How did you sleep last night?
*
Choose
Very well rested for a long time (8 hours +) - deep REM sleep
Couldn't sleep well (5 hours or less) - little to no REM sleep
Short amount of sleep but feel well rested (5 hours +)
Long amount of sleep but feel unrested (8 hours +)
How many bowel movements did you have today?
*
Choose
0
1
2
3
4
5+
Was your 1st poo of the day solid or loose?
*
Solid formed
Loose but not diarrhea
Diarrhea
Didn't poo today
Color of 1st poo of the day?
*
Greenish (light or dark)
Brownish (light or dark)
Orangeish
Black
Whitish
Grayish
Didn't poo today
Other:
Required
Was your 2nd poo of the day solid, loose, or diarrhea?
*
Solid formed
Loose but not diarrhea
Diarrhea
Didn't have a second poo today
Color of 2nd poo of the day?
*
Greenish (light or dark)
Brownish (light or dark)
Orangeish
Black
Whitish
Grayish
Didn't have a 2nd poo today
Other:
Required
Was your 3rd poo of the day solid, loose, or like diarrhea?
*
Solid formed
Loose but not diarrhea
Diarrhea
Didn't have a 3rd poo today
Color of 3rd poo of the day?
*
Greenish (light or dark)
Brownish (light or dark)
Orangeish
Black
Whitish
Grayish
Didn't have a 3rd poo today
Other:
Required
Did you find anything in your poo?
*
Candida (white chunks)
Pin worms
Tap worm
Hook worms
Didn't check or couldn't tell
Other:
Required
Are you taking any additional supplements?
Iodine
Collidal Gold
Collidal Silver
Multi-Vitamin
Vitamin D
Hydrogen Peroxide
Diatomaceous Earth
Other:
Free form to talk about anything else you have felt or experienced that is not already on the form.
Your answer
Submit
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