How to Use / Point Scale

Rate each of the following symptoms based upon your health for the past thirty (30) days on a scale of 0 to 4.

  • 0 = Never, or almost never have the symptom
  • 1 = Occasionally have it, effect is not severe
  • 2 = Occasionally have, effect is severe
  • 3 = Frequently have it, effect is not severe
  • 4 = Frequently have it, effect is severe

This interactive form will return a score for each section and a grand total upon completion. Be sure to look at your score before clearing the page as results are not cached.

Results Key to Questionnaire

  • Optimal Health – Less than 10
  • Mild Toxicity – 10 to 50
  • Moderate Toxicity: 50-100
  • Severe Toxicity: over 100

Medical Advice Disclaimer


No results are stored by Intellect Health LLC and this form is not monitored by Intellect Health LLC. The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you are having an emergency, please call 911.

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