Two Legs and Four Holistic Health - Body Cleanse and Detox Questionnaire

Two Legs and Four Holistic Health - Body Cleanse and Detox Plan Questionnaire
Toxins are now everywhere. Probably everyone is toxic to some degree. When we're naturally healthy, we can detox automatically. However, past toxins can block this natural tendency.

Sometimes we can pinpoint an event that triggered problems. Sometimes we can't.

Please fill out as much of the form as you can. Leave those areas that are not relevent.

This questionnaire is suitable for anyone - adults, children, animals.

PLEASE MAKE SURE YOU CLICK ON THE 'SUBMIT' BUTTON AT THE END.
Date*

DayMonthYear
Your name*

First NameLast Name
Preferred Name
Your country*
Primary E-mail*
Who is the patient?*

MeMy childMy catMy dogOther
If not you, please add their name below.
What is the year of birth.
What is the particular reason for this detox?
Do you have any feelings or thoughts on what the origin/s are?
What effect have they had?
Please list all the vaccines received, with dates, if possible. Start with the most recent ones.
What was the current state of health before the problem?
Please list the medical/veterinary drugs currently taken, with dosage.
Please list the supplements currently taken, with dosage.
Please list what you have already done to help the situation.
What effect did they have, that you noticed?
Any comments not already covered?
Should be Empty:

Two Legs and Four Holistic Health - Body Cleanse and Detox Plan Questionnaire