Chemical Hypersensitivity

Answer the questions below, using the symptom scale:

0=Never 1=Seldom 2=Occasionally 3=Frequently

4=Infrequently with severe symptoms 5=Almost always

Fatigue, lethargy, exhaustion

Overeating/ undereating

Numbness

Nausea

Blurred or dimmed vision

Impaired memory and thinking

Unwarranted depression

Arthritis

Weight loss

Eye irritation

Sore or irritated throat

Wheezing

Painful or irregular menstrual periods

Thyroid disease

Multiple sclerosis

Headaches

Dizziness

Birth defects in offspring

Persistent cough

General feeling of ill health

Emotional instability

Weakness

Muscle aches and pains

Burning sensations in mouth, throat, lungs

Menstrual abnormalities

Anaemia

Suspected dental toxicity

Insomnia

Uncoordination

Chest pains

Constipation

Loss of sense of smell

Flushing

History of miscarraige

Parkinson's disease

Flu-like symptoms that are not the flu

Behavioural or personality change

Hoarseness

Hives, rashes, acne

Infertility

Discomfort after fasting, or exertion

Tremors or seizures

Abdominal pain or cramps

Ulcerations in mouth

Low body temperature

Increased susceptibility to chronic fatigue syndrome, yeast overgrowth, food and inhalant allergies, autoimmune diseases

Unexplained lymph swelling

Amyotrophic lateral sclerosis

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