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Before You Detox

Before you begin the Core Restore detoxification program, it is important to first evaluate your current health state. This questionnaire will help identify signs of toxic burden. You will take this questionnaire again after your detox program to evaluate your progress. This will help you and your healthcare provider evaluate your success and continued improvement.

Fill Out Your Before You Detox Questionnaire 

POINT SCALE:      0 = Never      1 = Occasionally      2 = Frequently

Please add the totals from each section and write the section total in the spaces provided. Then, add all the section totals together and put that total in the space below.

Digestive
Bowel movements less than once per day
Bloated feeling
Belching and/or gas
Heartburn
Skin
Acne
Hair loss and/or hair thinning
Body odor
Excessive sweating
Eyes
Watery and/or itchy eyes
Swollen and/or reddened eyelids
Dark circles under the eyes
Blurred vision (excluding near- or far-sightedness)
Emotions
Mood swings
Feelings of fear and/or nervousness
Anger and/or irritability
Feelings of sadness
Heart
Skipped heartbeats
Rapid heartbeats
Chest discomfort
Mind
Poor memory and/or confusion
Difficulty concentrating
Poor coordination
Difficulty making decisions
Energy & Activity
Fatigue and/or sluggishness
Hyperactivity
Restlessness
Occasional sleeplessness
Other
Food sensitivities
Chemical and/or environmental sensitivities
Frequent and/or urgent urination
Bloating and/or mood swings before menstruation
Ears
Itchy ears
Earaches
Drainage from ear
Ringing in ears and/or hearing loss
Head
Headaches
Pressure
Dizziness
Faintness
Joints & Muscles
Pain or aches in joints and/or lower back
Stiffness and/or limitation in movement
Pain or aches in muscles
Feelings of weakness and/or tiredness
Nose
Stuffy nose
Sinus congestion
Sneezing
Mucus
Lungs
Shortness of breath
Difficulty breathing
Chest congestion
Weight
Underweight
Overweight
Difficulty losing weight
Crave certain foods
Mouth & Throat
Coughing
Gagging and/or frequent need to clear throat
Hoarseness and/or loss of voice
Dental problems

Please add the totals from each section and write the section total in the spaces provided. Then, add all the section totals together and put that total in the space below.

INTERPRETING YOUR TOXICITY SCORE:
Low Toxic Burden Recommended Detoxification Program
Moderate Toxic Burden Recommended Detoxification Program
High Toxic Burden Recommended Detoxification Program

Thanks for submitting!