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Toxicity Questionnaire Is Your Health Adversely Affected By Daily Exposures to and Ingestion of Toxic Substances from your Air, Food and Water, e.g., chemicals, metals, fumes, fiberglass, to name a few?
To Complete Your "FREE" Evaluation
To show our appreciation and to say "Thank You" for
subscribing, Dr. Smith offers your choice of one of four FREE
EVALUATIONS. Refer to right column for List of Free Evaluations and
link to their web pages, as well as information on obtaining additional
To obtain the Toxicity Questionnaire (TQ), please complete the "Evaluation Request Form." below. This
information is confidential and the
questions asked either assist us with processing your Questionnaire
for Evaluation or help us with demographic and marketing information.
Each question must be answered on the Request Form to receive your selected evaluation questionnaire. .
Your personal contact information on this Request
Form will only be used as it relates to processing your questionnaire
and Evaluation, unless you, otherwise, indicate on this form.
Upon receipt of your Evaluation Request Form, you will be emailed to you within 1-7 days with the User's Name and Password to access the web page titled, "EVALUATION - TOXICITY" so you may print its questionnaire, obtain the assessment (or evaluation) of your answers and Dr. Smith's recommendations.
Important Note: When you open the Evaluation web page, immediately click on the PDF Icon to print your questionnaire. Then complete your questionnaire before reading the Evaluation web page. Otherwise, the information on the Evaluation web page may influence your answers on the questionnaire.
up to one week?
1) Sending your password is not an auto-reply, 2) this allows us to
verify your subscription to our newsletter and/or your referred subscriber(s), which qualifies you for the
Evaluation(s) of your choice, and 3) due to the
volume of incoming Free Evaluations, this allows us time to assure that
we are able to fulfill all requests. Thank you for your patience.
How Do We Know Who Are Your Referred Subscribers? On the Evaluation Request Form below, you will be asked to enter the name and email address for each of your referrals if you know who they are when you complete this request form. If you do not know who or if you will refer anyone at this time, but later choose to do so, please ask the person you refer to put your name and email address on the Subscription Information Form, the space provided for "Who or What Referred You?" when they subscribe to our newsletter.
Please be sure that you add our email address to
"accepted email" feature so that your Questionnaire and issues of your HealthQuest
e-Newsletters will not go to Junk Mail. Thank you for
Should you have any questions about your
Questionnaire, the Evaluation Results or any information on its
Evaluation web page, please feel free to schedule an Inquiry Telephone
Consultation with Dr. Smith, at no charge, by calling (940) 761-4045.
Links to information on each Free Evaluation is provided in the right column so you may read about each one to make your selection. Thank you.
After reading this webpage regarding the Toxicity Questionnaire/Evaluation, you may click on the above links to review information on the other 3 of the 4 FREE Evaluations to make a decision regarding which FREE Evaluation you would like to select as our "Thank You For Subscribing." Then by referring three more friends to subscribe, you qualify for all Four Evaluations. Complete the EVALUATION REQUEST FORM to receive Passcodes to open web page for the Questionnaire and Evaluation you have selected.
Information provided in this website is for nutritional educational purposes only and not for the diagnosis, or treatment of any medical condition, disorder or disease.
Copyright 2004 Dr. Donna F. Smith -- Last Website Update: OCT 31, 2017 11:45 AM CST