Skip to content
Art of Detox
  • WHY DETOX
    • THE CLEANSES
    • PARASITES
    • TESTIMONIALS
    • ABOUT
  • KNOWLEDGE CENTRE
    • DETOX
    • VIDEOS
    • PARASITES
    • THE LIVER
    • THE BOWEL
    • THE KIDNEYS
    • KAMBÔ
    • ANIMAL COMMUNICATION
  • SHOP
  • NEWS
  • CONTACT
  • WooCommerce Cart0
    • WooCommerce My Account
      • Register

    Health Questionnaire

    Health QuestionnaireArt of Detox2023-02-15T14:22:52+00:00

    Health Questionaire

    A Self-Assessment

    "*" indicates required fields

    Step 1 of 15 - Personal Information

    6%
    Personal Information - 13/07/2025
    To eat when you are sick, is to feed your sickness.
    1.1 Name*
    1.2 Gender*
    1.6 Date of Birth*
    1.7 Address*
    1.11 Are you taking any medications? Please list individually below with dosages.
    Medications
    Dosage
     
    Click the + sign to add more lines
    1.12 Are you taking any Herbal Products or Supplements? Please list individually below:
    Click the + sign to add more lines
    1.13 What does your current daily diet consist of?*
    Breakfast
    Lunch
    Dinner
    Snack

    Genetic / Family History

    Please list all known health concerns for each family member. Leave blank if you aren't sure
    1.16.7 Sister/Brother
    Sister / Brother
    Health Concern
     
    Click the + sign to add more lines
    1.17 Your Previous Surgical Procedures
    Surgical Procedure
    Year
     
    Please list all surgical procedures, minor or major, along with the year. Click the + sign to add more lines

    Vitals Information

    (If you are not sure of your vital sign readings, you may leave them blank)
    People assume that having thyroid disease means you're older and overweight, but in reality, thyroid disease strikes at all ages and affects all sizes.
    3.1 Do you get cold hands and/or feet?*
    3.2 Do you feel cold often or have a hard time getting warm?*
    3.3 Are you cold, but burning inside?*
    3.4 Is it easy to put on weight and hard to lose it?*
    3.5 Do you have an irregular heartbeat?*
    3.6 Do you get headaches or migraines?*
    3.7 Do you become irritable easily?*
    3.8 Do you have low energy levels?*
    3.9 Do you have, or have ever had a goiter?*
    3.10 Have you been diagnosed with Hashimoto or Reidel disease?*
    3.11 Has a family member?*
    A Parathyroid Glandular is stronger and faster acting. Berries are good for the endocrine glands.
    4.1 Are your fingernails:*
    4.2 Do you have varicose or spider veins?*
    4.3 Do you, or have you had:*
    4.4 Do you experience cramping in your muscles?*
    4.5 Is your bladder strong or weak?*
    4.7 Have you ever had a hernia?*
    4.8 Have you ever had an aneurysm?*
    4.9 Do you have osteoporosis and/or score low on your bone density tests?*
    4.10 Do you have scoliosis?*
    4.11 Do you suffer from symptoms of depression?*
    4.12 Do you suffer from any other mental illness?*
    4.13 Do your tests come back showing low Calcium levels?*
    4.14 Do you have spine deterioration, herniated discs, or bone spurs?*
    4.15 Do your legs get tired or cramp after you walk?*
    4.16 Do you bruise easily?*
    5.1 Do you get gas after you eat?*
    5.2 Do you feel your foods just sitting in your stomach?*
    5.3 Do you have Acid Relfux?*
    5.4 Do you see any undigested foods in your stools?*
    5.5 Are you thin and have a hard time putting on weight?*
    5.6 Do your food pass right through you (diarrhea)?*
    5.7 Do you have moles in ypur body? (Adrenal & Pancreatic weakness)*
    6.1 Are you overweight?*
    6.2 Do you have:*
    6.3 Do you have anxiety attacks or feel overly anxious?*
    6.4 Do you feel excessive shyness or inferior to others?*
    6.5 Do you have tremors, nervous legs, etc?*
    6.6 Do you have High or Low Blood Pressure?*
    6.7 Do you have Hypoglycemia (low blood sugar)?*
    6.8 Do you have Diabetes (high blood sugar)?*
    6.8.1 Diabetes TYPE*
    6.9 Do you have tinnitis (ringing in the ears)?*
    6.10 Do you have S.O.B. (shortness of breath) or its hard to take a breathe?*
    6.11 Do you have arrhythmias?*
    6.12 Do you have a hard time sleeping or insomnia?*
    6.13 Do you have Chronic Fatigue Syndrome?*
    6.14 Have you been diagnosed with Addison's Disease or Congenital Adrenal Hyperplasia?*
    6.15 Do you have elevated blood cholesterol levels?*
    6.16 Do you have arthritis, bursitis, or any inflammatory issues?*
    6.17 Do you have low steroid or cortisol levels?*
    6.18 Have you been diagnosed with Autism?*
    6.19 Have you been diagnosed with ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder)?*
    7.1 Are your menstruation cycles irregular?*
    7.2 Do you have excessive bleeding during menstruation?*
    7.3 Do you have or have you had ovarian cysts?*
    Year
    7.4 Do you have or have you had endometriosis or A-typicall cells?*
    7.5 Do you have or have you had fibroids?*
    7.6 Do you have or have you had fibrocystic breasts?*
    7.7 Do you get sore breasts, especially during menstruation?*
    7.8 Do you have a low or excessive sex drive?*
    7.9 Have you had a hysterectomy?*
    7.9.2 Was it:*
    7.10 Did you take any other organs out at the same time? (i.e.:gallbladder)*
    7.12 Have you had a miscarriage?*
    7.13 Have you had difficulty conceiving children?*
    7.14 Have you been on Birth Control Pills?*
    7.15 Are you currently pregnant?*
    8.1 Do you have gastritis or enteritis?*
    8.2 Is your tongue coated (white, yellow, green or brown), especially in the morning?*
    8.3 Do you have gastroparesis?*
    8.4 Do you have a Hiatus Hernia?*
    8.5 Do you have Colitis?*
    8.6 Do you have Diverticultis?*
    8.7 Do you get or have Diarrhea?*
    8.8 Do you get or have Constipation?*
    8.9 Do you ever had stomach or intestinal ulcers?*
    8.10 Do you or have you had any type of gastro-intestinal cancers? (stomach, colon, rectal, etc.)*
    8.11 Do you have Crohn's Disease?*
    8.12 Do you have "gas" problems?*
    9.1 Do you have a problem digesting fats?*
    9.2 Do fats or dairy foods cause bloating and/or pain in the stomach area?*
    9.3 Are your stools white, or very light brown in color?*
    9.4 Do you get pain in the middle of your back (especially after eating)?*
    9.5 Do you get pain behind the right, lower rib area?*
    9.6 Do you have "liver" or brown spots on your skin? (not freckles)*
    9.7 Are you jaundiced (yellowing of the skin) or eyes?*
    9.8 Do you have any skin pigmentation changes?*
    9.9 Are you or have you ever been anemic?*
    9.10 Do you have or ever had, Hepatitis?*
    9.10.1 What Type?*
    9.11 Do you consume alcohol regularly?*
    9.12 Have you had your gallbladder or any other organ removed by surgery?*
    10.1 Do you get chest pains or angina?*
    10.2 Have you ever had a heart attack (Myocardial Infarction)?*
    10.3 Have you ever had a open-heart surgery?*
    10.4 Do you have heart arrhythmia's?*
    10.5 Do you feel pressure on your chest?*
    10.6 Do you get "prickly" pains anywhere, especially in the heart area?*
    10.7 Do you have, or have you ever has High Blood Pressure?*
    10.8 Do you have:*
    11.1 Do you get or have skin rashes?*
    11.2 Do you get skin blemishes?*
    11.3 Do you have Eczema or Dermatitis?*
    11.4 Do you have Psoriasis?*
    11.5 Do you itch anywhere?*
    11.6 Is your skin dry?*
    11.7 Is your skin excessive oily?*
    11.8 Do you get or have dandruff?*
    11.9 Do you have any other skin problems?*
    12.1 Do you have hair loss or are you bald or going bald?*
    12.2 Have you ever had Lymph Nodes removed?*
    12.3 Do you have any gray hair?*
    12.4 Do you have a hard time remembering things?*
    12.5 Do you ever get colds or flu-like symptoms?*
    12.6 Do you have fibromyalgia or sclerpderma?*
    12.7 Do you have sinus problems?*
    12.8 Do you have or get sore throats?*
    12.9 Do you have swollen lymph nodes?*
    12.10 Do you have or have you had tumors?*
    12.10.2 Type*
    12.11 Do you have a low platelet count (blood)?*
    12.12 Have you had appendicitis or an appendectomy?*
    12.13 Do you get boils, pimples, cysts, etc.?*
    12.14 Do you get regular exercise?*
    12.15 Have you ever had abscesses?*
    12.16 Have you ever had toxemia?*
    12.17 Do you have, or have you had, cellulitis? (not cellulite - this is different!)*
    12.18 Have you ever had gout?*
    12.19 Do you get blurred vision?*
    12.20 Do you have mucus in your eyes when you wake up in the morning?*
    12.21 Do you snore?*
    12.22 Do you have sleep apnea?*
    12.23 Have you had your tonsils out?*
    Kidneys and Bladder
    13.1 Have you ever had a urinary tract infection (UTI´s)?*
    13.2 Have you ever had "burning" upon urination?*
    13.3 Do you have problems holding your baldder? (parathyroid)*
    13.4 Have you ever had kidney stones?*
    13.5 Do you have bags under your eyes (esp. in the morning)?*
    13.6 Is your urine flow restricted?*
    13.7 Do you get cramping or pain on either side of your mid-to-lower back?*
    13.8 Do you or did you ever have nephritis?*
    13.9 Do you have lower back weakness?*
    13.10 Do you have or have you had sciatica?*
    13.11 Do you or did you ever have cystitis?*
    Lungs
    14.1 Do you get or have (or have had) bronchitis?*
    14.2 Do you get or have (or have had) emphysema?*
    14.3 Do you get or have (or have had) asthma?*
    14.4 Do you get or have (or have had) C.O.P.D.?*
    14.5 Are you on inhalers or nebulizers?*
    14.6 Do you have pain when you breathe?*
    14.7 Do you have pain when you take a deep breath? (adrenals)*
    14.8 Is it difficult to take a deep breathe?*
    14.9 Did you ever or do you have lung cancer?*
    14.10 Do you or did you have a collapsed lung?*
    14.11 Are you a smoker?*
    14.12 Have you ever had pneumonia?*
    14.13 Have you ever worked around toxic chemicals, in coal mines or around asbestos?*
    14.14 Do you cough a lot?*
    14.15 Do you remove any mucus when you cough?*
    Environmental and other Toxins
    15.1 Have you received any vaccines NOT INCLUDING the COV19 Vacciness?*
    15.1.2 Have you received any COV19 Vaccines?*
    When did you receive each?*
    1st Shot
    2nd Shot
    3rd Shot
    15.2 have you had shots for traveling to foreign countries?*
    15.3 Have you had Flu shots?*
    15.4 Do you have mercury Amalgams?*
    15.5 Have you been exposed to nuclear wastes or by-products, heavy metals or chemicals*
    15.6 Have you had Radiaton or Chemotheraphy?*
    15.7 Have you ever used any form of recreational drugs?*
    15.7.2 Do you still use them?*

    Title

    About Us | Disclaimer | Privacy Policy | Contact Us © 2025 ART OF DETOX built by Super8

    +1 843 561 4780 –  info@artofdetox.com

    This company states that we are not medical professionals; we do not diagnose or give medical advice. We only warrant that our products are 100% natural and non toxic. We make no claims about their efficacy but do record what they have done for people, whose testimonies speak for themselves. Every effort is made to corroborate these testimonies and if there is any doubt they are not recorded on the web site. We do not advocate that anybody ceases taking medication prescribed to them by their Doctors until they are advised by their GP or choose to by themselves. These statements have not been evaluated by the Food and Drug Administration and these materials and products are not intended to diagnose, treat, cure or prevent any disease.

    Page load link


    Go to Top