SYMPTOMS: FOOD: PREFERENCES
112.	Are you a picky eater?	Don't know No - I'll eat almost anything! No, but there are some things I don't like Somewhat Definitely
113.	Is your diet vegetarian or vegan? Vegetarians may eat eggs and/or dairy products, but no meat of any kind. Strict vegetarians (vegans) do not eat anything that comes from animals. Raw food vegans are vegans who eat most of their fruit/vegetables uncooked.	No Part-time - on average at least one day per week Vegetarian (eggs/dairy but no meat/fish/fowl) Vegan (I eat no animal products at all) More questions later... Raw food vegan (at least 70% raw fruit/vegetables) More questions later...
114.	Apart from moral objections, do you have a distaste for meat?	Don't know No Yes, moderate Yes, definite
115.	Do you generally feel like eating breakfast?	Always / don't know Usually About half the time Usually not Never
116.	Do you crave (have a strong desire for) prepared wheat products such as bread or pasta?	Don't know No Yes, but I never eat wheat products Yes, and I eat wheat products occasionally Yes, and I eat wheat products often
117.	Do you have a strong desire for either coffee or sugar in the afternoon?	No / don't know Yes, moderately Yes, very much
118.	Do you crave greasy or fatty foods?	No / don't know Yes, moderately Yes, very much
119.	Whether or not you believe that salt is good for you, how much do you like salty foods?	I dislike salty food / food often tastes too salty I avoid salt when I can It makes no difference / don't know I often like some extra salt I really love/crave salt
120.	Do you have a general craving for sugar or sweets, other than chocolate?	No / don't know Yes, moderately Yes, very much
121.	Do you crave chocolate?	Don't know No Yes, moderately Yes, very much
122.	Are there any foods that you eat often and would have difficulty giving up? Examples include bread, milk or cheese. If so, please make notes below.	No / don't know Probably Yes, definitely
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SYMPTOMS: FOOD: BEVERAGES
123.	What is your alcohol tolerance?	Very easily intoxicated (a couple of sips does it) I am easily intoxicated Average / don't know I am quite tolerant Very tolerant (I can drink all night)
124.	Have you ever consumed alcohol regularly?	No, none at all Never more than one drink per month Yes    More questions later...
125.	How many cups of caffeinated coffee do you drink per day?	None / don't know One Two Three Four or more
126.	How does coffee affect you? Adverse reactions include feeling 'wired', 'hyper' or jittery, nauseated or hungry.	I do very well on it It seems to benefit me slightly There is no particular effect / don't know Occasional adverse reaction Significant adverse reaction(s)
127.	On average, how much fruit or vegetable juice do you consume per day? One cup is 8 fluid ounces, or about 250ml.	None / rarely / don't know 1 cup 2 cups (500ml - half a standard carton) 3 cups (750ml) 4 cups (1 liter - a standard carton) or more
128.	Do you consume non-herbal ('ordinary') black tea?	No / rarely / don't know About one cup per day About two cups per day About three cups per day Four cups or more per day
129.	Do you consume green tea?	No / rarely / don't know About one cup per day About two cups per day About three cups per day Four cups or more per day
130.	Do you consume soft drinks containing caffeine? (Most soft drinks do contain caffeine. If unsure about those that you drink, answer this question assuming that they contain it.)	Never / rarely / don't know About once a week or less 2-6 times each week 1-4 times each day More than 4 drinks each day
131.	Do you consume soft drinks that do not contain caffeine? (Most soft drinks do contain caffeine. If unsure about those that you drink, do not answer this question.)	Never / rarely / don't know About once a week or less 2-6 times each week 1-4 times each day More than 4 drinks each day
132.	Do you consume low-calorie soft drinks (artificially-sweetened)?	Never / rarely / don't know About once a week or less 2-6 times each week 1-4 times each day More than 4 drinks each day
133.	Do you consume soft drinks that contain sugar (not artificially-sweetened)?	Never / rarely / don't know About once a week or less 2-6 times each week 1-4 times each day More than 4 drinks each day
134.	Approximately how much plain water do you drink on average per day? One cup is 8 fluid ounces, or about 250ml.	Don't know One cup (250ml) or less 2 cups (500ml) 3 to 4 cups (750ml to 1 liter) 5 cups (1.25 liters) or more
135.	How is your level of thirst generally?	I am never thirsty Rarely thirsty Average / sometimes thirsty / don't know Frequently thirsty Always thirsty
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SYMPTOMS: ENVIRONMENTAL EXPOSURE
136.	Have you suffered exposure to diesel exhaust fumes (as opposed to exhaust fumes in general)? For example, diesel mechanics, truck drivers, working at a truck stop, etc.	No exposure / don't know Light exposure for a short time Light exposure for a long time Heavy exposure for a short time Heavy exposure for a long time
137.	What has your exposure to air pollution (usually exhaust fumes) been?	Little or no exposure e.g. grew up in countryside Less than average Average exposure / don't know More than average High exposure: lived or worked near dense traffic
138.	Have you been exposed to solvents or other carcinogens through lungs or skin, for example working with paints, glues, fuels or other chemicals?	No / don't know Mild / short term, in the past only Heavy / long term, in the past only Moderate / short term current exposure Heavy / long term current exposure
139.	Have you had significant exposure to specific herbicides? Include short-term intense contact or long-term low-level exposure.	Don't know No Phenoxy agents (2,4-D, agent orange, 2,4,5-T) Glyphosates (roundup, touchdown…) Yes, other
140.	Are you exposed to chlorinated water either by drinking or bathing?	Don't know No Yes, use it for bathing only Yes, use it for drinking and bathing
141.	Have you done any dust-producing work in pre-1970 building(s)?	No / don't know Yes, but didn't live there during the work Yes, and lived there while the work was done Yes, more than one job but did not live there Yes, more than one job and lived there
142.	Have you been exposed to treated lumber sawdust, for example as a carpenter?	No / don't know Mild, in the past only Heavy, in the past only Moderate current exposure Heavy current exposure
143.	Are you regularly exposed to household mold (or mildew)? Mold prefers a damp, poorly-ventilated environment and can occur almost anywhere in the home, including walls, furniture and fabrics.	Don't know No There is a slight moldy/mildewy smell Yes, it is a definite but manageable problem There is a serious, uncontrollable mold problem
144.	Have you ever been diagnosed with mercury poisoning or toxicity?	Don't know Tests have confirmed there is no problem Yes, mild Yes, moderate Yes, severe
145.	Have you ever been diagnosed with heavy metal toxicity other than mercury?	Don't know Tests have confirmed there is no problem Yes, Mild Yes, moderate Yes, severe
146.	Are you sensitive to cigarette smoke?	No / don't know Mildly Moderately Seriously Severely
147.	Are you sensitive to chemicals (perfume, insecticides, exhaust fumes)?	No / don't know Mildly Moderately Seriously Severely
148.	Are you unusually sensitive to typical adult doses of prescription or over-the-counter medications? Indicators include regularly experiencing side-effects or finding that smaller-than-recommended doses usually suffice.	I don't use pharmaceutical drugs / don't know No, I am not It has been suggested Sometimes definitely Extremely
149.	Do you have Environmental Illness / Multiple Chemical Sensitivity?	No / don't know Probably - I have some minor reactions Quite likely - I have definite reactions Definitely / has been diagnosed / severe reactions
150.	How easily do you sunburn? Estimate the time it takes for you to get sunburned in full (midday) sun.	Very easily - under 10 minutes Easily - 10 to 20 minutes Average - 20 to 40 minutes / don't know Slowly - 40 minutes to 2 hours Very slowly - over 2 hours
151.	During your lifetime, how much have you been exposed to the sun?	Don't know Limited exposure, rarely enough to sunburn Moderate exposure / occasional light sunburn Significant exposure / frequent light burns Extreme exposure / frequent severe burns
152.	How much sun exposure have you had during the past 6 months?	Very little/rarely outdoors/always fully covered A little skin exposure for under 1 hour per week Arms/legs in full sun for at least 1 hour per week Much of body in full sun at least 2 hours per week Whole body in full sun at least 4 hours per week
153.	Do you experience a rash from sun exposure?	Don't know No Occasionally Regularly on facial cheeks Regularly anywhere besides the cheeks
154.	Temperature. How does being in the cold affect you?	I can't take it well It makes no difference / don't know I enjoy it, find it invigorating
155.	Temperature. How does being in the heat affect you?	I can't take it well It makes no difference / don't know I enjoy it
156.	Approximately how much time do you spend each WEEK looking at a computer screen?	Don't know None / under 1 hour 1-20 hours 21-60 hours Over 60 hours
157.	Approximately how much time do you spend each WEEK watching television?	Don't know None / under 1 hour 1-10 hours 11-30 hours Over 30 hours
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SYMPTOMS: MUSCULAR
158.	Tendonitis	Never had it / don't know Probably had it/minor episode(s) now resolved Major episode(s) now resolved Current minor problem Current severe problem
159.	For someone of your age and sex, is your muscular strength...?	Very poor Poor Average / don't know Great Very great
160.	How is your muscle tone, compared to others of your age?	Very poor (hypotonia) Poor Average / don't know Good Excellent
161.	How heavy (thick) would you say your overall musculature is naturally (without heavy exercise)?	Light / undersized About average / don't know Heavy / thick
162.	Is your reaction time / reflex...?	Very slow/poor Slow/poor Average / don't know Fast/good Very fast/good
163.	How strong are your tendon reflexes? A common example is a kick that is induced by gently tapping the front of the knee.	Non-existent Very weak Slight movement / average / don't know Definite movement Very strong
164.	Do you have pain between the shoulder blades?	No / don't know Yes, some Yes, significant
165.	Do your legs ever feel 'heavy', making it difficult to stand up, climb stairs, walk or stand?	Don't know No Sometimes Often, slightly Often, severely
166.	Have you had any problems with your muscles? This includes any muscular disease or specific problem like muscle loss, weakness, pain, spasms, twitching, cramping, tremors, tightness, rigidity, soreness, etc., but does not include seizure activity.	Don't know No Yes, I have muscular problems or disease More questions later...
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SYMPTOMS: SKELETAL
167.	Are you shorter than you used to be?	No / don't know Yes, an inch (2.5cm) or less Yes, more than one inch (2.5cm)
168.	How would you or others rate your posture? Poor posture usually consists of shoulders and head hunched forward, and the back bent forward. Good posture means that the ears, shoulders, hips, knees and ankles make a straight line, when viewed from the side.	Don't know Very poor Poor Average Excellent
169.	What is the length of your fingers and toes?	Very short / stubby Short / stubby Average / don't know Long / slender Very long / slender
170.	Do you suffer from osteoarthritis (wear and tear / age-related arthritis, NOT rheumatoid)?	No / don't know Mildly Moderately Seriously Severely
171.	Do you suffer from rheumatoid arthritis?	Never had it / don't know Probably had it/minor episode(s) now resolved Major episode(s) now controlled Current minor problem Current major problem
172.	Do you have arthritis that seems to migrate from joint to joint?	No / don't know Mild Moderate Serious Severe
173.	Do you have arthritis that seemed to appear after some physical, emotional or other stress?	No / don't know Mild Moderate Serious Severe
174.	Heberden's nodes. Do you have hard nodules on your finger joints caused by arthritis?	No / don't know A few, minor Several, minor A few, major Several, major
175.	Have you ever broken any bones?	No / don't know Once Twice Three times Four times or more
176.	Do you suffer from diffuse bone pain? In other words, do you have pain in your bones that is impossible to pinpoint? Do not include pain that is due to a known injury.	Pain is due to an injury / don't know No Slight, not always noticeable Significant or always noticeable Severe
177.	Have you ever had any dislocations?	No / don't know Yes, one Yes, more than one
178.	Have you had Bursitis (painful inflammation of joints, usually caused by overuse and/or excess pressure)?	No / don't know Some, in the past Numerous past episodes Current minor problem Current major problem
179.	Have you suffered from Carpal Tunnel Syndrome (pain in the wrists/hands)?	Never had it / don't know Probably had it/minor episode(s) now resolved Major episode(s) now resolved Current minor problem Current major problem
180.	Do you experience shoulder pain?	No / don't know One or both hurt, due to an injury Minor problem / comes and goes One hurts most of the time (not related to injury) Both hurt most of the time (not related to injury)
181.	Do you suffer from pain in your arms that is hard to pinpoint?	Don't know No Yes, moderate Yes, severe
182.	Do you suffer from pain in your hand(s) that is hard to pinpoint?	Don't know No Yes, moderate Yes, severe
183.	Do you suffer from heel pain? Include pain at your heel or slightly forward of the heel on the bottom of your foot.	Don't know No Yes, but I am uncertain of what the cause is Yes, diagnosed as plantar fasciitis Yes, plantar fasciitis with heel spur(s)
184.	Are you double-jointed?	No / don't know Somewhat Very
185.	Have you suffered from gout?	Never had it / don't know Probably had it/minor episode(s) now resolved Major episode(s) now resolved Current minor problem Current severe problem
186.	Have you ever had a herniated disc ("slipped disc")?	No / don't know Probably Yes, one minor episode Yes, several minor or one major episode Yes, several major episodes
187.	Do you have a history of stress fractures?	No / don't know Yes, one Yes, several
188.	Do you seem to have relaxed ligaments or loose joints?	No / don't know Yes, somewhat Yes, very
189.	Have you suffered TMJ (Tempero-Mandibular Joint, hinge of the jaw) malfunction involving clicks, pops, locking or noises?	Never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
190.	Do your joints click or pop?	No / don't know One or two, barely noticeably Several, barely noticeably One or two, noticeably (audibly) Several, noticeably (audibly)
191.	Do you suffer from chronic pain from any joint in your body (neck, back, knee, elbow, ankle, etc.) that is associated with a past injury or abuse?	No / don't know Mildly Moderately Seriously Severely - excruciating
192.	Do you have pain, stiffness or swelling in any of your joints that is not associated with a past injury or abuse?	No / don't know Minor in one or two joints Minor in several, or moderate in one or two Major in one or two, or moderate in several Major, in several joints
193.	Do you have a stiff or painful neck? Do not include problems due to physical injury or poor sleeping position.	Don't know No Yes    More questions later...
194.	Do you suffer from lower back pain that is not caused by a known injury?	No / rarely / I was injured / don't know Minor problem now resolved Major problem now resolved Current/chronic minor problem Current/chronic significant problem
195.	Do you experience hip pain?	No /don't know In the past only Minor problem / comes and goes Major problem in one hip Major problem in both hips
196.	Have you suffered from sciatica (pain going down one or both legs)?	I never had it / don't know Probably/minor episode now resolved Major episode now resolved Current minor problem Current major problem
197.	Do you suffer from morning stiffness or stiffness that is generally increased in the morning?	No / don't know Yes, some Yes, severe
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GLOSSARY

Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Bursitis
The bursa is a fluid-filled pad that allows your muscles to easily slide over other muscles and bones. Bursitis occurs when this pad becomes inflamed. It usually occurs when you overuse or injure a specific joint, but it can also be caused by a bacterial infection. Symptoms include pain and inflammation around joints such as the elbow, hip, shoulder, big toe, ankle or knee.

Carpal Tunnel Syndrome
A common, painful defect of the wrist and hand. It is caused by pressure on the middle nerve in the carpal tunnel. The syndrome is seen more often in women, especially in pregnant and in menopausal women. Symptoms may result from a blow, swelling, a tumor, rheumatoid arthritis, or a small carpal tunnel that squeezes the nerve. Pain may be infrequent or constant and is often most intense at night.

Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.

Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.

Crave (Craving, Cravings)
To have a strong desire for; to feel the need for.

Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.

Double-jointedness (Double-jointed)
Having unusually flexible joints that can bend in unusual ways or to an abnormally great extent.

Gout
A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.

Heberden's Nodes
Bony swellings around the margins of joints, associated with degenerative changes of arthritis.

Herniated Disc
A patient with a herniated or "slipped" disc can have leg and/or back pain. The most common complaint is that of shooting pain down one or, uncommonly, both legs. The pain will typically travel from the back or buttocks to below the knee. The second possible symptom is back pain. Patients often report a history of back pain that occurred before the actual herniation. Many patients recall an episode of their back "going out" or of significant pain that resolved over a period of days with rest and was usually not accompanied by leg pain.

Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.

Milliliter (mL)
0.001 or one thousandth of a liter.

Multiple Chemical Sensitivity (Chemical Hypersensitivity, Environmental Illness, MCS)
The diagnostic label of Multiple Chemical Sensitivity (MCS) is being applied increasingly, although definition of the phenomenon is elusive. MCS has become more widely known and increasingly controversial as more patients receive the label. Persons with the label of multiple chemical sensitivity are said to suffer multisystem illnesses as a result of contact with - or proximity to - a spectrum of substances, including airborne agents. These may include both recognized pollutants and other pollutants ordinarily considered harmless. Some doctors believe that MCS is a purely psychological issue. Others, however, counter that the disorder can cause the kinds of problems that keep those who are affected from leading a normal life.

Osteoarthritis (Osteoarthritic)
A condition involving degeneration of cartilage and supporting joint tissue, which results in pain, swelling and reduce