Immune & Inflammatory Stress

Do you have a history of joint pain, rashes, autoimmune diagnoses (like thyroid or lupus), or frequent infections?

No, none of these

Mild or occasional symptoms

Diagnosed with one autoimmune condition

Diagnosed with multiple conditions or frequent flare-ups

Environmental Exposures

Do you have long-term exposure to mold, mercury fillings, or chemicals (e.g., cleaning products, smoke)?

No known exposures

Possibly, unsure

Past exposure to one of these

Multiple ongoing exposures

Digestive Function

Do you experience bloating, reflux, constipation, or food sensitivities?

Never or rarely

Occasionally

Frequently

Diagnosed GI condition (IBS, GERD, etc.)

Nutritional Habits

How would you describe your diet?

Mostly whole and organic

Balanced, occasional processed

Regularly eat processed or sugary foods

Poor diet, mostly processed

Urinary Symptoms

Do you experience puffiness, foamy urine, or frequent urination?

Never

Occasionally

Two symptoms ongoing

Frequent/severe symptoms

Hormone & Sleep

Do you struggle with poor sleep, fatigue, or hormone issues?

No

Mild or rare

Moderate

Severe or diagnosed imbalance

Lifestyle & Medication Load

Do you regularly use NSAIDs, eat poorly, or experience chronic stress?

No or very rarely

1 factor applies

2–3 factors apply

All of the above

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