The RBE Toxicity Quiz: How Full Is Your Rain Barrel?

Similar documents
28-DAY CLEANSE GUT C.A.R.E. by Dr. Vincent Pedre. Pre-Program Medical Symptoms Questionnaire

New Client Health & Wellness Paper Work

Office Use. Stage of. Technique/Plan +/- Change. Establishing Your Health Goals. Date: Name: Age: Referred by:

GET OFF YOUR ACID 7-DAY SUMMER CLEANSE Client Workbook

GENERAL INFORMATION (Please print)

WOODLANDS FAMILY CHIROPRACTIC

NeuroSolutions Initial Intake

Symptom Review (page 1) Name Date

WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS

Emotional Relationships Social Life Sexually Recreation

Have you ever been diagnosed with any of the following? The patient has a history of the following conditions: Glaucoma

What do you believe is causing your most important health concern?

SHEILA WOLFSON, M.Ed., C.N.S. Nutritionist and Health Counselor. 20 Main Street, Suite 300, Natick, MA Phone/Fax (508)

MEDICAL QUESTIONNAIRE (male)

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP

Alternative Health Care Center Dr. Marc D Andrea DC, CC

*521634* Sleep History Questionnaire. Name of primary care doctor:

RHEUMATOLOGY PATIENT HISTORY FORM

MenoChat. City State Zip Code. Employer Job Title. Primary Care Provider Phone: History. Desired Outcome:

Address: City State Zip. Address: Father/Mother/Guardian: Phone:( )

Patient Information. Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland

Silver Child Development Center New Patient Questionnaire. Relation (circle) Biological Mother Stepmother Adoptive Mother

ACUPUNCTURE FOR HEALTH WENDY STALKER R.Ac. Dip.Ac. B.Sc. Name: Date of Birth: Date:

New Patient Medical History Intake Form

The Rehabilitation Institute Cancer Rehabilitation

MEDICAL QUESTIONNAIRE (female)

Patient History Form

NEW PATIENT INTAKE FORM

Client Intake and Health History. Diet, Nutrition and General Health Practices

My energy is lower than I would like it to. I feel exhausted after exercising or physical activity.

Patient Intake Form for Acupuncture Treatment at Infinite Healing

Nutrient Assessment Chart

Sleep History Questionnaire

Joseph S. Weiner, MD, PC Patient History Form

What do you feel are your child s strengths at this time?

Patient Health History for Fertility

Scottsdale Family Health

New Patient Sleep Intake

Home Address: City: State: Zip Code: Referral Source (Therapist, Treatment Program, Etc...): Name: Age: Gender: Name: Age: Gender: Name: Age: Gender:

Symptom Questionnaire

Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1

PERSONAL MEDICAL AND FAMILY HISTORY Please check applicable boxes.

Inner Balance Acupuncture

HORMONE QUIZ Time to get clear about your symptoms

Healing a Leaky Gut All disease begins in the gut Hippocrates

Welcome to West Functional Chiropractic

Headache Follow-up Visit Form

CENTRAL CARE POLICY SYMPTOMS OF ILLNESS. Policy: Consumers will be observed for symptoms of physical problems, distress, pain, or unusual behaviors.

Patient Information & Health History

Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address

ANTI-DEPRESSANT MEDICATIONS

205 W Giaconda Way, Suite 135 Tucson, AZ, (520) Name: Birth date: Age: Today s Date:

Metabolic Assessment Form

Essential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM

Natalie Kilheeney L.Ac., Dipl. OM Licensed Acupuncturist & Herbalist

Head To Heal Acupuncture Intake

Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Patient General Information

ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac

Address: Phone: Date of Birth: / / Major Complaints: 1) 3) 2) 4)

Medical History Form

Creve Coeur Family Medicine, LLC

The Art of the Follow-Up

PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID (208)

HORMONE QUIZ Time to get clear about your symptoms

The Rehabilitation Institute Cancer Rehabilitation

New Patient Questionnaire

PULMONARY MEDICINE PATIENT QUESTIONNAIRE

Patient Health History

Sleep Center New Patient Questionnaire

Session 4 Our physical reaction to stress: physical tension

Medical Questionnaire

GoPrivateMD General Information & History

Questionnaire for Lipedema Patients

COUPLE & FAMILY INSTITUTE OF TRI-CITIES AMEN ADULT GENERAL SYMPTOM CHECKLIST

Who is filling out this intake form? Self Spouse Parent Guardian

Hormone Evaluation Quiz

Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in.

Pure Health Natural Medicine

Medical History Form

Candida Questionnaire: Are your health problems yeast connected?

ENVIRONMENTAL HISTORY SYSTEMS REVIEW FORM NAME DATE

The Food Intolerance Institute of Australia

Welcome to Lincoln Chiropractic Wellness

Natural Health Center

Willow Naturals BioEnergetic Health Survey

ACTION CHIROPRACTIC & SPORT THERAPY 7744 Elbow Drive SW Calgary, AB T2V 1K2 Phone: Fax: Full Name: Address:

New Patient Information

DePaul Pediatric Health Questionnaire (Child Version)

American Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ (520)

INTEGRATIVE MEDICINE CONSULTATION INTAKE FORM. We look forward to working with you to achieve your optimal health and well- being!

New Sleep Patient Questionnaire. Name Age Date. General Medical History 1. Please list any surgeries you have had and their approximate dates:

Amarillo Surgical Group Doctor: Date:

EMORY SLEEP CENTER Sleep and Health Questionnaire

Medical Intake Form. Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip:

Eastern Body Therapy

Dexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop.

OU Children s Physicians Pediatric Arthritis Center

Transcription:

The RBE Toxicity Quiz: How Full Is Your Rain Barrel? In industrialized societies cancer is second only to cardiovascular disease as a cause of death. But in ancient times, cancer was extremely rare. There is nothing in the natural environment that can cause cancer. - Professor Rosalie David Most people that live with aches, pains, fatigue, and health issues think this is just a normal part of aging But nothing about living that way is normal and it s unfortunate we ve been led to associate the aging process automatically as a forgone conclusion that our body is going to start to break down and we re going to have to suffer from disease, weight gain, flabby muscles, and fatigue. It truly doesn t have to be that way and it s my life s work to show you how to reverse your current state, but before we get there I d like you to assess where you re presently at. To do that, I ve given you my private Functional Medicine Detox Assessment to find your level of total toxic load and build up. To complete the toxicity questionnaire and find your personal results score, simply fill in the blank with a 0, 1, 2, or 3 depending on your typical symptoms 0 = Never feel this symptom 1 = Feel this symptom 1-2 times per month 2 = Feel this symptom weekly 3 = Feel this symptom daily

Head Headaches/Migraines Dizziness/Faintness Neck tension Cloudy head Sinus Nasal congestion (stuffy nose) Allergies (seasonal or daily) Mucus Sneezing Nose blowing Eyes Dark circles under eyes Bags under eyes Itchy eyes Discharge or watery eyes Blurred vision Crusted eyes upon waking Ears Itchy ears Discharge or drainage from ears Ringing in ears, tinnitus Excessive wax build up Blocked or muffled hearing Teeth Pain in gums or teeth Bleeding gums Silver fillings (Score with a 3 if you have any metal fillings) Metal crowns or Root canals (Score a 3 for crowns or root canals) Mouth Canker sores Cold sores (herpes virus) Cracking on lips

Discolored lips White film on lips upon waking or after eating Tongue Red dots on tongue Sides of tongue have dents ( scalloping ) White, yellow, or brown coating on tongue Cracks or lines on tongue Glands Swollen lymph nodes (neck, armpits, or groin) Difficulty swallowing Loss of voice Swollen ankles or wrists/hands/fingers Breathing Chest tension Inability to get enough air in Chest congestion Chronic cough Clear throat a lot Voice hoarseness Weight Difficulty losing weight Gain weight easily Feel swollen or puffy Retain water Binge or compulsive eating Joints/Muscles Pain in joints Muscle stiffness Limited range of motion Muscle weakness/loss of strength Arthritis Skin Acne

Hair loss Flushing/Hot flashes Dry, flaky skin Excessive sweating Hives or itchiness Psoriasis, eczema, ringworm or skin rashes Sleep Inability to fall asleep Can t stay asleep/wake up frequently Nightmares Heart racing at night Night sweats Energy Tired upon waking Daytime or afternoon fatigue General lack of energy Apathy Lack of ambition or drive Hyperactivity (can t sit still have to always be doing something) Restlessness (feel uncomfortable with quiet) Tap feet or shake leg or hands when seated Decreased libido or sexual function Digestion Get tired after meals (especially lunch) Bloating Gas Belching/Burping Heartburn or indigestion Diarrhea Constipation Stomach or intestinal pain Nausea or vomiting Stomach sticks out more as day progresses Mind Lack of concentration Easily distracted or lose train of thought

Difficulty making decisions Brain fog Stuttering or difficulty putting together sentences Uncoordinated or drop things ADD/ADHD or learning disabilities Emotions Anxiety Overwhelm Irritability Anger or rage Dark thoughts Sad for no reason Mood swings Depressed High-strung Seasonal Affective Disorder (SAD) Immunity (Score each question below with 10 points if you answered yes) Frequent colds (more than 2-3 illnesses a year) Allergies (environmental or non-fatal food sensitivities) Pneumonia (Score with a 10 if yes within the last 12 months) Diagnosed disease (Score with a 10 if you have a diagnosed disease) Unexplained illness (Score with a 10 for an undiagnosed disease) Total Score Grand Total Score (add up your total points from above) Scoring Take a look at your overall quiz results and see which health sections you seem to be doing the best and what areas need some work. Those are the areas where you have underlying imbalances that must be corrected.

After adding up your total point total see what toxicity stage you re at below: Stage 1: 0-9 Points Congratulations it looks like you re doing great! You appear to be well and it seems like you have your health under control. Just make sure you are not filling up your rain barrel with continued stress, lack of sleep, poor eating, etc. My recommendation in terms of detoxification at this point is only a seasonal 7-day detox to keep up with and remove the continual accumulation of toxins. Do also try to incorporate a healthy daily routine as shared later in this book in order to stay well and balanced. Stage 2: 10-19 Points It looks like you re doing pretty well, but you re starting to see the effects of hidden toxicities expressing themselves on the outside as symptoms. It s also at this point that you may be moving towards a disease state unless you begin to Empty Your Rain Barrel TM. A formal 7, 14, or 21-day detox is advised and then seasonal detoxes after that to maintain optimal health and balance. I also highly recommend incorporating the daily healthy living routines shared later in the DESTRESS Protocol TM. Stage 3: 20+ Points Your body is now showing signs of toxic overload and total body burden. Most likely, you are feeling the effects of this toxicity in your daily life in terms of inflammation, lowered vitality, lowered mood, and less overall get up and go. A 21-day detox is recommended followed by a seasonal 7, 14, or 21-day detoxes to decrease toxic accumulation until you reach a score of 10

points or less. At that point you can simply drop down to one 7-day detox seasonally/quarterly. This is also the time to pay special attention to each step in the DESTRESS Protocol TM coming up soon. How to Do a Functional Medicine Detox How to complete a 7, 14, or 21-day Functional Medicine Detox will be explained in the following chapters and summed up in the last section of the Rain Barrel Effect for easy reference. You will also learn the daily detox methods you can use to lighten your total body burden, as well as alternative non-toxic recommendations to keep yourself healthy going forward. Lastly, each time you complete a 7, 14, or 21-day detox please retake this RBE Toxicity Quiz to see how your score has decreased. And remember, my total toxicity score on this test used to be well over 100 pts! Now, it remains below 10 points and I want to show you how to do the same. Authorized Reprint This is an authorized reprint of Dr. Stephen Cabral s toxicity quiz from his original book, the Rain Barrel Effect. To find out more about Dr. Cabral s Functional Medicine Detox that he uses in his private practice please see, DrCabralDetox.com for details.