Pre and Post Assessment Questionnaire

Doing a pre and post assessment is essential for evaluating the effectiveness of a detoxification protocol. It provides a baseline for comparison, allowing individuals to determine whether they have experienced any changes in their health and well-being as a result of the protocol.

The pre-assessment can help identify any underlying health issues or symptoms that may be exacerbated by the detox protocol. It also helps determine the individual’s current health status and provides a reference point for comparison after the detox is completed.

The post-assessment provides an opportunity to evaluate the effectiveness of the detox protocol and identify any areas that may need improvement. It allows individuals to assess the changes that have occurred as a result of the detox, including improvements in energy levels, mental clarity, digestion, and other health markers.

Complete the questions before before and after completion of the detoxification protocol.

Make sure to also complete the “review of systems” questionnaire before and after the protocol.

Pre-Assessment

1. What is your primary reason for wanting to complete a detoxification protocol?
2. Have you ever completed a detoxification protocol before? If yes, please describe your experience.
3. How would you rate your current energy levels? (1-10)
4. How would you rate your current sleep quality? (1-10)
5. How would you rate your current stress levels? (1-10)
6. How often do you exercise per week?
7. Do you have any known food allergies or intolerances?
8. Do you experience any digestive issues such as bloating, gas, or constipation?
9. How often do you consume alcohol, caffeine, and/or tobacco?
10. Have you been exposed to any environmental toxins or heavy metals?

Post-Assessment

1. How would you rate your overall experience with the detoxification protocol? (1-10)
2. Have you noticed any improvements in your energy levels? If yes, please describe.
3. Have you noticed any improvements in your sleep quality? If yes, please describe.
4. Have you noticed any improvements in your stress levels? If yes, please describe.
5. Have you noticed any improvements in your digestion? If yes, please describe.
6. Have you noticed any improvements in any other areas of your health? If yes, please describe.
7. Did you experience any side effects during the detoxification protocol? If yes, please describe.
8. Would you consider completing a detoxification protocol again in the future?
9. Would you recommend a detoxification protocol to a friend or family member?
10. Is there anything else you would like to share about your experience with the detoxification protocol?

Review of Systems (Pre and Post)

A review of systems assessment is an important tool for assessing the overall health and function of the body before and after a detoxification protocol. Below are some key areas to consider. Add total score together and see if you improved upon completion of a detox. This can also help identify areas that may require additional support or intervention.

Rate each of the following symptoms based on the following point scale:

• 0: Never or rarely experienced
• 1: Occasionally experience but is usually not significant
• 2: Occasionally experience and is significant
• 3: Frequently experience but is usually not significant
• 4: Frequently experience and is significant

Digestive Health

Bloating _______

Gas _______

Constipation _______

Diarrhea _______

Heartburn _______

Indigestion _______

Nausea _______

Vomiting _______

Belching _______

Intestinal / Stomach pain _______

Musculoskeletal and Joint Pain

Pain or aches in joints _______

Pain or aches in muscles _______

Feelings of weakness _______

Arthritis _______

Stiffness _______

Weight

Food cravings _______

Overweight _______

Binge eating _______

Energy

Fatigue _______

Skin

Acne _______

Rashes _______

Hair loss _______

Flushing _______

Excessive sweating _______

Dry or itchy skin _______

Cardiovascular

Irregular heartbeat _______

Rapid heartbeat _______

Cognitive

Poor Memory _______

Confusion _______

Poor Concentration _______

Difficulty making decisions _______

Emotional

Mood Swings _______

Anxiety _______

Anger or Irritability _______

Depression _______

Other

Frequent cold or illness _______

Asthma _______

Headaches _______

Poor sleep _______

Watery or itchy eyes _______

Itchy ears _______

Ringing in ears _______

Earaches _______

Sinus problems _______

Stuffy nose _______

Excessive mucus _______

Canker Sores _______

Sore throat _______

Swollen tongue, gums, or lips _______

Total score

Add total for each section and then add all sections together.

Digestive Health: _______

Musculoskeletal and Joint Pain: _______

Weight: _______

Energy: _______

Skin: _______

Cardiovascular: _______

Cognitive: _______

Emotional: _______

Other: _______

Total Score: _______

Remember to complete these questions before and after the detox.