Organic Herbal Colon Cleanse Australia

Is My Colon Toxic Questionnaire

Listed in this questionnaire are symptoms. Your answer comes up at the top of the page when you have finished.

A= symptom never occurs
B= symptom occurs often
C= symptom occurs occasionally
D= symptom occurs most of the time
Total Score (A + B + C + D) =
Name A B C D
1.Unable to Mentally Focus?
2.Feeling Blocked?
3.Night Sweats?
4.Feeling Depressed?
5.Bouts of Feeling Unwell?
6.Lazy Bowel?
7.Diarrhea Alternating With Constipation?
8.Thinning or Loss of Hair?
9.Food Sensitivities
10.Body Aches and Pain?
11.Suffer With Allergies
12.Diarrhea?
13.Bad Breath?
14.Overall Body Odor?
15.Excessive Smelly Fatulence
16.Abdominal Bloating//Tenderness?
17.Skin Problems Dry/Acne?
18.Foggy Brain?
19.Fluctuations in Weight ?
20.Problems Sleeping?
21.Stomach Feels Bloated?
22.Yeast/Fungus Infections
23.Passing Smelly Poo?
24.Abdominal Pain?
25.Low Energy/Fatigued
26.Feeling Sluggish?
27.Unexplained Headaches
28.Low Blood Pressure?
29.Painful Spasms and Stomach Cramping?
30.Low Energy?