Gut Health Survey

The questions in this survey are intended to paint a picture of your health from the inside. Some of the questions may seem quite personal, please be assured that your responses will be separate from your identity.

Participant ID (for practitioner)

Optional

What is your gender?(Required)

What is your age range?(Required)

How many bowel movements per typical week?(Required)

Most common consistency of stool?(Required)

Recent pain in your abdomen(Required)

Recent cramping in your abdomen(Required)

Recent bloating or distension in your abdomen(Required)

Recent flatulence & aroma(Required)

Prevalence of brain fog(Required)

Feeling of fatigue(Required)

Sleep disruption(Required)

Moodiness(Required)

Prevalence of skin rash(Required)

Prevalence of joint pain(Required)

Recent hair loss(Required)

Steady weight gain(Required)

Please share anything you think might be helpful