Toxins/Chemicals Exposure Quiz

Welcome!

The old saying, "What you don't know can't hurt you!" is not always good advice.

When it comes to environmental toxins, WHAT YOU KNOW CAN HELP YOU!

Chronic accumulation of environmental toxins is a well-known contributing factor to many wellness issues!

This quiz is intended to raise your awareness level regarding your past, present, and future choices that may be contributing to a problem that may have a significant price the longer it is ignored.

Let's get started!

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DISCLAIMER: Nothing in this quiz is intended as a diagnosis or treatment of any medical condition, whatsoever. This quiz is not intended to diagnose, treat, cure, or prevent any disease.

Offered By

First Name

Last Name

Advisor Phone Number

ZOI Corporate Email

I experience the following... (check all that may apply)* This field is required.

Headaches

Mental "Fogginess"

Memory Problems

Digestive Problems

Poor Sleep

Frequent Irritability

Eye Problems

Kidney Problems

Random Tingling Problems

Deteriorating Wellness

Skin Problems

None

I notice my experiences are worse during... (check all that may apply)* This field is required.

Spring

Summer

Fall

Winter

No notable differences

I notice my experiences are worse when... (check all that may apply)* This field is required.

I am at home

I am at work

I am in a specific room

I am in a specific location

Does not apply to me

I have used tobacco products on a regular basis within the past six months.* This field is required.

Yes

I am exposed to second-hand cigarette smoke on a regular basis.* This field is required.

Yes

Currently, I have this number of mercury amalgam dental fillings (silver/porcelain fillings) in my mouth.* This field is required.

I have had my mercury amalgam dental fillings (silver/porcelain fillings) removed.* This field is required.

Yes

I took necessary precautions* BEFORE removing my mercury amalgam dental fillings (silver/porcelain fillings).* This field is required.* Doctors and individuals request the removal of their amalgam (silver-mercury) restorations due to the high mercury content. A safe protocol to replace the silver mercury filling will ensure that there is minimal if any absorption of materials while being removed.

Yes

I use the following personal care products... (check all that may apply)* This field is required.Frequent = 2+ times per week

Regular deodorant

Non-toxic deodorant

Regular toothpaste

Non-toxic toothpaste

Regular haircoloring

Non-toxic haircoloring

Regular bath/shower products

Non-toxic bath/shower products

Name-brand cosmetics

Paraben-free cosmetics

Whatever is least expensive

Whatever is most expensive

Perfume/cologne/after shave

I consume canned beverages and/or canned food products, frequently.* This field is required.For this quiz, "frequently" means consuming canned beverages 2+ times per week. Canned beverages may include soda, beer, tea, water, etc.

Yes

I eat fast-foods frequently.* This field is required.For this quiz, "frequently" means consuming fast-foods 2+ times per week.

Yes

I choose the following food types when available.* This field is required.

Non-organic

Organic

I eat the following seafood on a frequent basis... (check all that may apply)* This field is required.Frequent = 2+ times per week

Farm-raised seafood

Wild-caught seafood

Smoked seafood

Sushi

I do not frequently consume seafood

I use the following type cookware to prepare my foods. (check all that may apply)* This field is required.

Teflon-coated (ceramic, aluminum)

Ceramic

Solid Stainless Steel

Solid cast iron

Solid Aluminum

Aluminum clad w/Stainless Steel

Solid Copper

Copper clad w/Stainless Steel

Stoneware

Enameled

Glass

Not sure

My primary drinking water source is...* This field is required.

unfiltered city water

filtered city water

bottled water

water from well

spring water

water delivery service

self-service water refill stations

I use plastic containers or plastic wrap when using my microwave oven.* This field is required.

Yes

I get at least 7 hours of uninterrupted sleep per night on a regular basis.* This field is required.According to a 2018 study of more than 10,000 people, the body's ability to function declines if sleep isn't in the 7-8 hour range.

7 hours or greater

Less than 7 hours

SECTION I: MY WELLNESS EXPERIENCES SCORE

SECTION I

MY WELLNESS EXPERIENCES SCORE

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I best describe where I reside as...* This field is required.

near the city limits

near the country/rural

near open farmlands

near highways/busy streets

near source of air/water pollution

near pollution source/landfill

near high-powered electrical wires

near a golf course

I use household air fresheners, candles, or plug-ins.* This field is required.

Yes

I use chemical-based household cleaning products.* This field is required.

Yes

I use scented laundry products.* This field is required.This includes laundry detergent, dryer sheets, fabric softeners, perfumed pellets, etc.

Yes

I spray my shower walls with chemical cleaners to keep them clean.* This field is required.

Yes

I use pesticides, herbicides and other chemicals when I garden.* This field is required.

Yes

I treat my property with chemicals for weeds, pests, etc.* This field is required.

Yes

My property is treated with chemicals...* This field is required.

Weekly

Monthly

Bi-Monthly

Quarterly

Bi-annually

Annually

Occasionally

SECTION II: MY DAY-TO-DAY EXPOSURES SCORE!

SECTION II

MY DAY-TO-DAY EXPOSURES SCORE

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I do work or have worked in the following occupations... (check all that may apply)* This field is required.

Firefighter

Military

Automobile mechanic

Auto body repair

Aircraft plant worker

Commercial farming

Landscaping

Hairdresser/Barber

Nail salons

Dry cleaning

Carpet Installer

Construction

Painting

Printing shop

Welding

Steel Mills

Factory assembly line

Swimming pool maintenance

Water treatment facilities

Chimney technician

None of these apply to me

I have worked with the following harsh chemicals... (check all that may apply)* This field is required.

Wood-finishing chemicals

Glues

Solvents

Gasoline

Bleach

Acids

Weedkillers (ie. glyphosate)

Beauty-related chemicals

Paint/Electroplating/Anodizing

Formaldehyde

No, this does not apply to me

I have lived or worked in a structure built before the 1978 ban on lead-based paints for residential use.* This field is required.NOTE: Lead-based paints were banned for residential use in 1978. Homes built in the U.S. before 1978 are likely to have some lead-based paint. When the paint peels and cracks, it makes lead paint chips and dust.

Yes

I have lived or worked in a structure built before the enactment of the 1986 Safe Drinking Water Act.* This field is required.*NOTE: In 1986 Congress Amended the Safe Drinking Water Act, prohibiting the use of pipes, solder or flux that were not “lead free” in public water systems or plumbing in facilities providing water for human consumption.

Yes

I have lived or worked in a structure with exposure to poor air quality (constant fumes, smoke, asbestos, etc.)?* This field is required.

Yes, ventilation is not adequate

No, ventilation is adequate

I have lived or worked in a structure that was water-damaged.* This field is required.

Yes

I have lived or worked in a structure with obvious mildew and/or a musty, damp odor?* This field is required.

Yes

I have lived or worked in a structure where I was exposed to consistent types of smoke.* This field is required.Examples of smoke may include cigarette, cigar, vaping, exhaust, etc.

Yes

My home or occupation structure has... (check all that may apply)* This field is required.

Freshly painted walls

New carpet/flooring

New furniture

Recent remodeling

Fireplace

Wood-burning stove

No, this does not apply

SECTION III: MY HOME & OCCUPATION STRUCTURE EXPOSURES SCORE!

SECTION III

MY HOME & OCCUPATION STRUCTURE EXPOSURES SCORE

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The value I place on my OVERALL WELLNESS is...* This field is required.0=Lowest, 10=Highest

I am satisfied with my current overall wellness.* This field is required.0=Disagree, 100=Agree

I take supplements to support my optimal wellness.* This field is required.

Yes

My awareness level of how environmental toxins impact my body's biochemical pathways is...* This field is required.

I have ZERO awareness

I have a SIGNIFICANT awareness

I have previous exposure concerns

I am concerned

I am not concerned

I don't care about the issue at all

Name* This field is required.Please provide your preferred name.

First Name

Last Name

E-mail Address* This field is required.Please provide your preferred email address to email your responses.

My Phone NumberIf desired, please provide your preferred contact number.

My GenderIf desired, please provide your gender.

Male

Female

My Age Group If desired, please provide your current age group.

18-24

25-38

39-50

51-64

65+