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0 = None or never 1 = Slightly or rarely 2 = Mild or occasionally 3 = Moderately or frequently 4 = Severe or often
Do you have symptoms that are aggravated by air pollution? 0 1 2 3 4 Are you sensitive to smoke, perfume, or other chemical odors? 0 1 2 3 4 Do you have ongoing problems with fatigue? 0 1 2 3 4 Do you suffer from joint or deep muscle pain? 0 1 2 3 4 Do you have a significant environmental expowsure to poollutants at work or at home? 0 1 2 3 4 Rate your use of tobacco products. 0 1 2 3 4 Rate your exposure to second hand smoke. 0 1 2 3 4 Rate your consumption of alcoholic beverages. 0 1 2 3 4 Rate your unprotected exposure to sunlight or ultraviolet light. 0 1 2 3 4 Rate your level of exercise. 0 1 2 3 4 What is your exposure to prescription, over-the-counter medications, and/or recreational drugs? 0 1 2 3 4 Rate your daily stress level. 0 1 2 3 4 Rate your intake of fried foods, margarine, or high-fat foods. 0 1 2 3 4 How often do you seek medical care or advice for your health concerns? 0 1 2 3 4 Total :
If you scored more than 20 total points, your reserves of antioxidants may be low and need supplementation. If you find yourself in this situation and would like further assistance, please fill out the information below and submit the form. All information and recommendations will be strictly confidential. If you find yourself with a large number of the above symptoms, it is very that a comprehensive natural anti-inflammatory life style combined with high quality anti-oxidant supplementation will help restore your health.
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