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Toxicity Questionnaire

The Toxicity and Symptom Screening Questionnaire identifies symptoms that help to identify the underlying causes of illness, and helps you track your progress over time. Rate each of the following symptoms based upon your health profile for the past 30 days. If you are completing this after your first time, then record your symptoms for the last 48 hours ONLY.

Step 1 of 4

Head

Eyes

Ears

Nose

Mouth/Throat

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