Yes	No
		Q01  Are you a current or former smoker?
		Q02  Do you work or socialize around smokers?
		Q03  Do you eat meat?
		Q04  Do you eat dairy products?
		Q05  Do you have less than one bowel movement per day?
		Q06  Are you presently on heavy medications or drugs (legal or  illegal)?
		Q07  Do you not exercise regularly?
		Q08  Are you more than 20 pounds overweight?
		Q09  Do you drive in congested traffic, or live near air pollution?
		Q10  Do you drink less than five glasses of water daily?
		Q11  Do you eat less than one serving of fresh fruit and one  serving of fresh vegetables (salad, steamed/raw  vegetables, sprouts, etc.) daily?
		Q12  Do you work in an industrial environment with a lot of  chemicals?
		Q13  Do you take laxatives?
		Q14  Does your family have a history of short life span?
		Q15  Do you have mucus problems? (stuffy nose, sinus  congestion, etc.)?
		Q16  Do you have bad body odor when not using deodorant?
		Q17  Do you have "bad breath"?
		Q18  Do you get sick easily?
		Q19  Do you have any major illness?
		Q20  Do you ever have heartburn or indigestion?
		Q21  Do you drink Caffinated Drinks/Coffee?
		Q22  Are you out of breath when you walk up a flight of stairs?
		Q23  Do you ever eat wheat products ie Breads, Pasta, Pizza?
		Q24  Do you drink alcohol regularly?
		Q25  Do you have a stressful life?
		Q26  Have you recently been Separated/Divorced?
		Q27  Do you have little or no patience with your children and  partner?
		Q28  Do you ever suffer from headaches or irritability?
		Q29  Do you eat any processed foods?
		Q30  Do you want to take control of your own Life?

   

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