If none of the options apply, please leave them blank.
Do you or have you:
Personal Care Products (PCP)
Do you use personal care products?
Have you ever been or are you currently exposed to the following? (home, work, school, travel, etc.)
Persistent Organic Pollutants (POPs)
Electromagnetic Frequencies (EMFs)
Do you or have or do you have any of these habits that may protect your health:
This information is brought to you in collaboration with the National Association of Environmental MedicineCopyright NAEM, 2020www.envmedicine.com