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OMDetox Health Quiz

Body toxicity quiz

Answer honestly to all the questions above and Dominique will get back to you with her diagnosis. You will obtain advices to improve your health with specific lifestyle changes, based on the answers you gave.

Do you suffer from constipation or slow digestion?

No Sometimes Yes, it's chronic

Are you low on energy in the middle of the day, constantly tired or lacking motivation?

No, lots of energy Tired sometime Always tired

Do you have high levels of cholesterol?

Yes No

Do you have high blood pressure?

Yes No

Are you diagnosed with Diabetes?

No Yes, Type 1 Yes, Type 2

Do you experience acid reflux after eating?

Yes No

Do you have any nutritional deficiencies?

Yes No

Do you have food allergies or intolerances?

Yes No

Have you had a parasitic infection (Eg. Traveler’s diarrhea) in the last 12 months?

Yes No

Do you have acne, eczema, psoriasis or other skin problems?

Yes No

Do you have food allergies or intolerances?

Yes No

Do you have chronic bad breath or strong body odour?

No Bad breath Strong body odour Both

Do you experience pain, bloating or gas after eating?

Yes No

Do you suffer from mood swings, depression or anxiety?

Yes No

Do you drink alcohol, coffee or sodas every day?

Alcohol Coffee Soda All of the above No

Do you eat mostly organic food?

Yes No

Do you eat processed food?

Yes No

How would you qualify your diet?

I eat meat, fish, poultry and dairy Paleo Vegetarian Vegan

Would like to lose weight?

Yes No

Do you have other health concerns?

What do you wish to achieve by doing a cleanse?

Have you ever done a detox before (If yes, what kind)?

What are your health goals?

Name

Your Age

Country

Email (Please provide a valid email address)

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