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Infinite Health
3 Step Detox
Dr. George Traitses
D.C.,B.Sc.(Hon.),M.Sc.,C.H.N.,
C.C.R.D.,C.N.M, ACRB 1,
C.R.A

Clinic
2914 Sheppard Ave. East.,
Suite 206
(just east of Victoria Pk. Ave.).
Scarborough, Ontario
M1W 3P4

Home/Office
90 Fincham Ave,
(First light east of Hwy 48 & 16th Ave.)
Markham, Ont.
L3P 4E1

phone: 416-499-5656
1 866-499-5656
fax: 416-499-5797
webmaster@infinite-health.com

3stepdetox.ca

3 Step Detox

3 Step Detoxification Symptom Questionnaire

Rate each of the following symptoms based upon your typical heath profile.

0 – Never or almost never have the symptom 1 – Occasionally has it, effect is not severe

2- Occasionally have it, effect is severe 3 – Frequently has it, effect is not severe

4 – Frequently has it, effect is severe Download pdf file

Digestive

	Mood swings
	Anxiety, fear, nervous
	Anger, irritability
	Depression
	Total

Emotions

	Watery, itchy eyes
	Swollen, reddened, eyelids
	Dark circles under eyes
	Blurred, tunnel vision
	Total Score

Eyes

	Chest congestion
	Asthma, bronchitis
	Shortness of breath
	Difficulty breathing
	Total Score

Nose

	Headaches
	Faintness
	Dizziness
	Insomnia
	Total Score

Head

	Poor Memory
	Confusion
	Poor concentration
	Poor coordination
	Difficulty making decisions
	Stuttering, stammering
	Slurred speach
	Learning disabilties
	Total Score

Mind

	Skipped heartbeats
	Rapid heartberats
	Chest pain
	Total Score

Energy/Activity

	Itchy ears
	Earaches, ear infections
	Drainage from ears
	Ringing in ears, hearing loss
	Total Score

Ears

	Chronic coughing
	Gagging, need to clear throat
	Sore throat, hoarse
	Swollen or discolored tongue, gums or lips
	Canker sores
	Total Score

Mouth-Throat

	Acne
	Hives, rashes, dry skin
	Hair loss
	Flushing, hot flashes
	Excessive sweating
	Total Score

Joints/Muscles

	Binge eating/drinking
	Craving certain foods
	Excessive weight gain
	Compulsive eating
	Water retention
	Underweight
	Total Score

Weight

	Frequent illness
	Frequent, urgent urination
	Genital itch, discharge
	Total Score

Grand Total___________


	Add up the numbers to arrive at a total for each section, then add totals for each section to arrive at the grand total. If any individual section totals is 10 or more, or the grand total is 14 or more, you may benefit from a 3 Step Detoxification Program.


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