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Food & Environmental Sensitivities Questionnaire

These are common symptoms of food or environmental sensitivities. They affect your body's ability to function. If you have many of these symptoms, your body is probable reacting to something that you are eating, drinking or have been exposed to.

The listed symptoms have more than one cause and are not a direct indication of a food or environmental sensitivities. However, they are very good indicators of hidden problems affecting your health and well being.
This gives you a general “yes” or “no” answer to the question, “Do I have Food & Environmental Sensitivities?”

0 1 2 3 4 5	Do you experience anxiety or depression
0 1 2 3 4 5	Do you have ADD/ADHD
0 1 2 3 4 5	Do you experience inability to concentrate
0 1 2 3 4 5	Do you experience cloudy or foggy thinking
0 1 2 3 4 5	Do you have learning disabilities
0 1 2 3 4 5	Do you stutter or have slurred speech
0 1 2 3 4 5	Do you experience mental confusion, lethargy or dullness
0 1 2 3 4 5	Do you experience irritability or aggressive behavior
0 1 2 3 4 5	Do you have felling of restlessness
0 1 2 3 4 5	Do you have insomnia
0 1 2 3 4 5	Do you experience dizziness
0 1 2 3 4 5	Do you feel drowsy or sleepy soon after eating
0 1 2 3 4 5	Do you have headaches
0 1 2 3 4 5	Do you feel fullness in the head
0 1 2 3 4 5	Do you have recurrent sinusitis
0 1 2 3 4 5	Do you have stuffy or runny nose often
0 1 2 3 4 5	Do you have excessive mucous
0 1 2 3 4 5	Do you have frequent or unexplained hoarseness
0 1 2 3 4 5	Do you have chronic cough
0 1 2 3 4 5	Do you experience chest congestion
0 1 2 3 4 5	Do you have sore throat often
0 1 2 3 4 5	Do you have blurry vision
0 1 2 3 4 5	Do you have watery eyes
0 1 2 3 4 5	Do you have dark circles under your eyes
0 1 2 3 4 5	Do you hear ringing in your ears
0 1 2 3 4 5	Do you have recurrent ear infections
0 1 2 3 4 5	Do you experience hearing loss
0 1 2 3 4 5	Do you have itching ears or ear drainage
0 1 2 3 4 5	Do you have canker sores
0 1 2 3 4 5	Do you experience heart palpitations
0 1 2 3 4 5	Do you have asthma
0 1 2 3 4 5	Do you experience nausea or vomiting
0 1 2 3 4 5	Do you have diarrhea or constipation
0 1 2 3 4 5	Do you experience bloating alter meals
0 1 2 3 4 5	Do you experience belching
0 1 2 3 4 5	Do you have colitis
0 1 2 3 4 5	Do you suffer from abdominal pains or cramps
0 1 2 3 4 5	Do you have hives
0 1 2 3 4 5	Do you have rashes
0 1 2 3 4 5	Do you have eczema, dermatitis
0 1 2 3 4 5	Do you have cravings
0 1 2 3 4 5	Do you feel itchy without apparent reason
0 1 2 3 4 5	Are you chronically tired and fatigued
0 1 2 3 4 5	Do you have muscle weakness, aches and pains
0 1 2 3 4 5	Do you have joint aches and pains
0 1 2 3 4 5	Do you experience swelling of the hands, feet, or ankles
0 1 2 3 4 5	Do you experience vaginal itching, and/or discharge