Section 1a Diet, Lifestyle, Symptoms and Medical History

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* 1. What is your full name?

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* 2. How much of the food you eat each week is 'spray-free' or organically grown or raised?

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* 3. How often do you eat fruit?
One serve = one handful

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* 4. How often do you eat vegetables (excluding potatoes)?
One serve = one handful

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* 5. How often do you eat animal products? (e.g. dairy foods, eggs, poultry, red meat or fish)

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* 6. Do you drink filtered water?

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* 7. How often would you have tinned food?

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* 8. How often do you eat 'fast' or 'junk' food? (e.g. takeaway, deep fried, snack food)

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* 9. How often do you drink more than 4 standard alcoholic drinks in one session?

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* 10. Do you use 'social' or 'recreational' drugs? (e.g. marijuana, ecstasy, etc.)

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* 11. How many 'personal care' products do you use? (e.g. soap, cleanser, shampoo, conditioner, antiperspirants, moisturiser, special creams, cosmetics: foundation, eyeliner, eyeshadow, lipstick, perfumes)

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* 12. Do you feel unusually tired?

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* 13. Do you have any skin issues? (e.g. acne, eczema, rashes)

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* 14. Do you suffer from headaches or migraines?

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* 15. Do you suffer from allergies or asthma?

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* 16. Total Score for Section 1a (please tally and enter)

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