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Website (leave blank)

Glyphosate Test

Welcome to the survey. Please take a few minutes.

This value was reported by the laboratory (Example input: 1.23)

The sample came from this country:

I live at this postal code: (We want to create a contamination map based on this value)

Gender of the participant

Male

Female

Age group of the participant

Current weight in kg

Height of the participant

How many kilograms did the participant lose in the last six months before submitting the sample?

How often do you eat out? Others cook for you, you have little control over the ingredients

Organic quality when shopping - How does it look?

Now follow questions about your eating habits.

Please choose the frequency that fits best.

Baked goods (wheat, spelt, rye)

Muesli, oat flakes

Cornflakes

Milk

Yogurt

Curd cheese

Cheese

Soy

Corn

Sugar

Sweets

Rapeseed oil

Olive oil

Lentils

Beans

Peas

Chickpeas/flour

Potatoes (regular)

Vegetables (all types)

What are the typical vegetables in your kitchen?

Fruit (all types)

What are the typical fruits in your kitchen?

Meat / Sausage (all types)

What are the typical meat/sausage products in your kitchen?

Eggs

Quality of eggs

Which beverages are predominantly consumed in your household? Please include brand names For tea, please specify variety and source

What is the proportion of tap water in your daily beverages? (in %)

What is your email address (in case of questions)

Which diseases are present? (Multiple selection possible)

none

ADD / ADHD

Alzheimer

Listlessness

Asthma

Autism

Autoimmune diseases

Bipolar disorder

Breast cancer

Ulcerative colitis / IBS / Celiac disease

Dementia

Depression

Depressive moods

Diabetes Type II

Hashimoto's disease

Learning difficulties in children

Stomach ulcers

Gastritis

Migraine

Multiple sclerosis (including suspected)

Hypothyroidism

Sleep disorders

Parkinson's disease

Prostate cancer

Reflux/Heartburn

Growth disorders in children