Got Metals?

Mercury/Toxic Sensitivity Questionnaire

1.            Sore gums (Gingivitis)?            Yes            No

2.            Mental symptoms such as confusion, forgetfulness?            Yes            No

3.            Severe depression?            Yes            No

4.            Ringing in ears (Tinnitus)?            Yes            No

5.            TMJ (Temporal Mandibular Joint) problems?            Yes            No

6.            Unusual Shakiness (tremors) of hands or arms,                       

            or twitching of other muscles?            Yes            No

7.            "Brown spots" or "Age Spots"            Yes            No

8.            Colds, flu, infectious diseases?            Yes            No

9.            Food allergies or intolerances?            Yes            No

10.            Have you been to many doctors for your health problems,                       

            only to hear that "There is nothing wrong"?            Yes            No

11.            Numbness, burning in mouth and gums?            Yes            No

12.            Numbness or unexplained tingling in arms and legs?            Yes            No

13.            Difficulty in walking (ataxia)?            Yes            No

14.            4 or more "silver" fillings?            Yes            No

15.            A "metallic" taste in mouth?            Yes            No

16.            Worked as a painter or in manufacturing/chemical.                       

            pesticide/fungicide factories (fungicides with methyl                       

            mercury or in pulp/paper mills that used mercury?            Yes            No

17.            Ever worked as a dentist, hygienist, or dental assistant?            Yes            No

18.            Candida-Related Complex (CRC) or yeast infections?            Yes            No

19.            Bad breath (halitosis) or white tongue (thrush)?            Yes            No

20.            Low basal body temperature (below 97.4 degrees F)            Yes            No

21.            Constipation?            Yes            No

22.            Heart irregularities or rapid pulse (tachycardia)            Yes            No

23.            Arthritis?            Yes            No

24.            Mucus in stools?            Yes            No

25.            Chest pains?            Yes            No

26.            Poor sleep or insomnia?            Yes            No

27.            Frequent kidney infections or kidney problems?            Yes            No

28.            Extreme Fatigue?            Yes            No

29.            Irritability or dramatic changes in behavior?            Yes            No

30.            Using antidepressants?            Yes            No

31.            Do you have trigeminal neuralgia or other neuralgias?            Yes            No

 If you answered "yes" to 3 or more of these questions, then you may need chelation.  Go to http://dasilvainstitute.com/chelation.asp to learn more about this FDA approved method of safely removing heavy metals.