Parasite Full Moon Detox

Name *

First Name

Last Name

Constipation (pooping one or fewer times a day) *

0-Never

1-Occasionally

2-Often

3-Regularly

Feeling that bowels do not empty completely *

0-Never

1-Occasionally

2-Often

3-Regularly

General or chronic fatigue *

0-Never

1-Occasionally

2-Often

3-Regularly

Mood problems; anxiety, depression, or bipolar *

0-Never

1-Occasionally

2-Often

3-Regularly

Poor brain processing (cognition) *

0-Never

1-Occasionally

2-Often

3-Regularly

Chronic inflammation *

0-Never

1-Occasionally

2-Often

3-Regularly

Wake up between 1am-4am *

0-Never

1-Occasionally

2-Often

3-Regularly

Edema, swelling or retain extra fluids *

0-Never

1-Occasionally

2-Often

3-Regularly

Skin problems, rashes, itches, hives, eczema, or acne *

0-Never

1-Occasionally

2-Often

3-Regularly

Yellowish skin, face *

0-Never

1-Occasionally

2-Often

3-Regularly

Suppressed immune system *

0-Never

1-Occasionally

2-Often

3-Regularly

Can't clear infections, despite following pathogen protocols *

0-Never

1-Occasionally

2-Often

3-Regularly

Sore or swollen breast tissue *

0-Never

1-Occasionally

2-Often

3-Regularly

Heart palpitations, or irregular heartbeat *

0-Never

1-Occasionally

2-Often

3-Regularly

Light, sound or EMF sensitivities *

0-Never

1-Occasionally

2-Often

3-Regularly

Morning stiffness *

0-Never

1-Occasionally

2-Often

3-Regularly

Brain fog *

0-Never

1-Occasionally

2-Often

3-Regularly

Swollen glands *

0-Never

1-Occasionally

2-Often

3-Regularly

Cellulite or flabby skin *

0-Never

1-Occasionally

2-Often

3-Regularly

Varicose or spider veins *

0-Never

1-Occasionally

2-Often

3-Regularly

Kidney problems *

0-Never

1-Occasionally

2-Often

3-Regularly

Breathing or lung issues *

0-Never

1-Occasionally

2-Often

3-Regularly

Skin doesn't sweat *

0-Never

1-Occasionally

2-Often

3-Regularly

Puffy eyes *

0-Never

1-Occasionally

2-Often

3-Regularly