Please put an X by all the following symptoms that apply to you. When you’re finished, add the scores next to those you have marked.
1. Numbness and tingling in extremities 2. Twitching of face and other muscles 3. Tremors or shakes of hands, feet, head, etc. 4. Jumpy, jittery, nervous 5. Unexplained chest pains 6. Tachycardia 7. Unexplained rashes or skin irritations 8. Excessive itching 9. Bloated feeling most of the time 10. Frequent or recurring heartburn 11. Constipation on a regular basis 12. Frequent diarrhea 13. Constant or very frequent periods of depression 14. Unexplained irritability 15. Sudden, unexplained or unsolicited anger 16. Constant death wish or suicidal intent 17. Difficulty in making even simple decisions 18. Cold hands and feet, even in moderate/warm weather 19. Get out of breath easily 20. Get headaches just after eating 21. Experience frequent leg cramps 22. Constant or frequent metallic taste in mouth 23. Burning sensation on the tongue 24. Constant or frequent ringing or noise in ears 25. Frequent urination during the night 26. Unexplained chronic fatigue 27. Difficulty remembering or use of memory 28. Constant or frequent pain in joints 29. Frequent insomnia 30. Unexplained fluid retention
* Have you ever had silver-colored fellings in your teeth?
* Do you smoke or have you smoked?
* Have you received vaccinations?
Please check below if you are employed in any of these occupations, or if you are involved in similar activities as hobbies.
If you checked a dozen or more of these symptoms, you may have problems with Heavy Metal Toxicity.
Total:
Score of 97-150: High toxicity exposure.
Score of 31-96: Moderate to high toxicity exposure.
Score of 0-30: Mild toxicity exposure.
