Parasite Questionnaire

PARASITE QUESTIONNAIRE: There are many causes for each symptom listed below.

Assign points to each symptom to see if a pattern develops.

A = symptom never occurs.

B = symptom occurs occasionally.

C = symptom occurs regularly.

D = symptoms occurs frequently.

		A	B	C	D
1.	Restless sleep (toss, turn, wake often)	0	1	2	3
2.	Skin problems, rashes, itches	0	1	2	3
3.	Increased appetite, hungry after meals	0	1	2	3
4.	Frequent diarrhea, loose stool	0	2	3	4
5.	Grinding of teeth when asleep	0	2	4	6
6.	Variable, changeable consistency of stool	0	1	2	3
7.	Picking at nose, boring nose with finger	0	2	4	6
8.	Abdominal pains	0	1	2	3
9.	Vertical wrinkles around mouth	0	2	4	6
10.	Rectal, anal itch	0	2	3	4
11.	Parallel lines (tracks) in soles of feet	0	2	4	6
12.	Intestinal cramps, burning	0	1	2	3
13.	Irritable (no apparent reason)	0	1	2	3
14.	Feel bloated, gaseous, no known cause	0	2	3	4
15.	Diarrhea alternates with constipation	0	2	3	4
16.	Bowel urgency, occasional accidents	0	1	2	3
17.	Hyperactive tendency (nervous)	0	1	2	3
18.	Dark circles under eyes	0	2	3	4
19.	Need for extra sleep, wake unrefreshed	0	1	2	3
20.	Allergies, food sensitivities	0	1	2	3
21.	Fevers of unknown origin	0	1	2	3
22.	Night sweats (not menopausal)	0	1	2	3
23.	Kiss pets, allow pets to lick your face	0	2	3	4
24.	Anemia	0	1	2	3
25.	Frequent colds, flu, sore throats	0	1	2	3
26.	Go barefoot in parks, public streets	0	2	3	4
27.	Travel in 3rd world countries	0	2	4	6
28.	Eat lightly cooked pork products	0	2	3	4
29.	Eat sushi, sashimi	0	2	4	6
30.	Sleep with pets on bed	0	2	3	4
31.	Bed wetting	0	1	2	3
32.	Men: sexual dysfunction	0	1	2	3
33.	Forgetfulness	0	1	2	3
34.	Slow reflexes	0	1	2	3
35.	Loss of appetite	0	1	2	3
36.	Yellowish face	0	1	2	3
37.	Heart beat rapid	0	1	2	3
38.	Heart pain	0	1	2	3
39.	Pain in umbilicus	0	1	2	3
40.	Blurry, unclear vision	0	1	2	3
41.	Pain: back, thighs, shoulders	0	1	2	3
42.	Lethargy, apathy	0	1	2	3
43.	Numbness, tingling in hands, feet	0	1	2	3
44.	Burning pains in the stomach, intestines	0	1	2	3
45.	Menstrual problems	0	1	2	3
46.	Dry lips during day, damp at night	0	1	2	3
47.	Drooling while asleep	0	1	2	3
48.	Occult blood in stool (from lab test)	0	1	2	3
49.	History of giardia, pin worms, worms	0	2	3	4
50.	Swim in creeks, rivers, lakes	0	1	2	3
TOTAL
	TOTAL 10-14 points = maybe 15-20 points = suspect parasites 21-25 points = likely (further testing helpful) 25 or more points = parasite involvement probable

Want more info or to book an appointment for a parasite cleanse? Contact me here: http://fitnhealthynutrition.com/contact-us/

Parasite Questionnaire

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