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Comprehensive Toxicity Questionnaire

Comprehensive Toxicity Questionnaire

Congratulations on taking action to find out about your health! Please rate each symptom based on how you have been feeling in the past 30 days. Your progress through the survey can be seen in the progress bar at the top of the page. Once we receive your results, we'll compile them and let you know your score and what it means. This is a manual process, so please allow 2-3 days for your results to be emailed to you.

1. Please enter some basic details so that we can contact you with your results.

2. Gastrointestinal

Belching or gas

Please select one answer below

Bloating or abdominal discomfort shortly after eating.

Please select one answer below

Bad breath (halitosis)

Please select one answer below

Aggravated by certain foods

Please select one answer below

Diarrhea, chronic

Please select one answer below

Undigested food in stool

Please select one answer below

Constipation

Please select one answer below

Nausea or vomiting

Please select one answer below

Fewer than one bowel movement a day

Please select one answer below

Stools are loose and unformed

Please select one answer below
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