Toxicity Assessment Form

Please fill out this form and click “Submit” at the bottom. Thank you!

If you have any questions, don’t hesitate to ask.

Please answer the following questions related to your lifestyle and habits that may contribute to overall toxicity.

Please rate the next questions on a scale of 1 to 10. With 10 being severe/chronic problems.

 

Thank you so much for your time and participation in this study.