ACIDIC TOXIC SELF TEST

ACIDIC TOXIC SELF TEST
Rate each of the following symptoms based upon your profile for the past 30 days:
POINT SCALE:

0=never or almost never have the symptom
1=occasionally have it, effect is not severe
2=occasionally have it, effect is severe
3=frequently have it, effect is not severe
4=frequently have it, effect is severe

DIGESTIVE
__ Nausea or vomiting
__ Diarrhea
__ Constipation
__ Bloated feeling
__ Belching, passing gas
__ Heartburn
__ TOTAL

EARS
__ Itchy ears
__ Earaches, ear infection
__ Drainage from ear
__ Ringing in ears hearing loss
__ TOTAL

EMOTIONS
__ Mood swings
__ Anxiety, fear, nervousness
__ Anger, irritability
__ Depression
__ TOTAL

ENERGY/ACTIVITY
__ Fatigue, sluggishness
__ Apathy, lethargy
__ Hyperactivity
__ Restlessness
__ TOTAL

EYES
__ Watery, itchy eyes
__ Swollen, reddened or sticky eyelids
__ Dark circles under eyes
__ Blurred/tunnel vision
__ TOTAL

HEAD
__ Headaches
__ Faintness
__ Dizziness
__ Insomnia
__ TOTAL

HEART
__ Skipped heartbeats
__ Rapid heartbeats
__ Chest pain
__ TOTAL

JOINTS/MUSCLES
__ Pain or aches in joints
__ Arthritis
__ Stiffness, Limited movement
__ Pain, aches in muscles
__ Feeling of weakness or tiredness
__ TOTAL

GRAND TOTAL = ____

LUNGS
__ Chest congestion
__ Asthma, bronchitis
__ Shortness of breath
__ Difficulty breathing
__ TOTAL

MIND
__ Poor memory
__ Confusion
__ Poor concentration
__ Difficulty making decisions
__ Stuttering, stammering
__ Slurred speech
__ Learning disabilities
__ TOTAL

MOUTH/THROAT
__ Chronic coughing
__ Gagging, frequent need to clear throat
__ Sore throat, hoarse
__ Swollen or discolored tongue, gums, or lips
__ Canker sores
__ TOTAL

NOSE
__ Stuffy nose
__ Sinus problems
__ Hay fever
__ Sneezing attacks
__ Excessive mucus
__ TOTAL

SKIN
__ Acne
__ Hives, rashes, dry skin
__ Hair loss
__ Flushing or hot flashes
__ Excessive sweating
__ TOTAL

WEIGHT
__ Binge eating/drinking
__ Craving certain foods
__ Excessive weight
__ Compulsive eating
__ Water retention
__ Underweight
__ TOTAL

OTHER
__ Frequent illness
__ Frequent or urgent urination
__ Genital itch, discharge
__ TOTAL

Add up the numbers to arrive at a total for each section, then add the totals for each section to arrive at the grand total. If any individual section total is 10 or more, or the grand total is 50 or more, you may benefit from the pH Miracle Living Program.
No one cares more about your health than you do!

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