We encounter a wide range of substances and environmental factors throughout everyday life from the food and water we consume to the products we use and the places where we live and work. This self-assessment gives you an opportunity to step back and review some of these potential exposures in one place.
Free to Download
The questionnaire explores four key areas:
Food & Water
What you eat and drink, including food sources, processed foods and water sources.
Home & Work Environment
Potential exposure to mould or water damage, chemicals, pollutants, pesticides, fumes and other environmental factors.
Travel & Recreation
Exposure through outdoor environments, travel and hobbies involving chemicals or other substances.
Medical & Personal Care
Sensitivities to personal-care products, fragrances, smoke, medications, dental materials, food and environmental allergens, as well as other personal factors.
Your provider can discuss your responses with you.