Free Online Health Evaluation

The Gut Health Evaluation

Part 01

Rate your answers (0 being least/never, 3 being most/always)
Name*

First NameLast Name
Email*
[email protected]
Phone Number

Country CodeArea CodePhone Number
Age*
Sex*
Please list your 3 major health concerns in order of importance*
utm_source

I feel that bowels do not empty completely*

0123

I experience lower abdominal pain relieved by passing stool or gas*

0123

I experience alternating constipation and diarrhea*

0123

I experience diarrhea*

0123

I experience constipation*

0123

I experience hard, dry, or small stool*

0123

I experience coated tongue or “fuzzy” debris on tongue*

0123

I pass large amount of foul-smelling gas*

0123

I experience more than 3 bowel movements daily*

0123

I use laxatives frequently*

0123

I experience excessive belching, burping, or bloating*

0123

I experience gas immediately following a meal*

0123

I have offensive breath*

0123

I experience difficult bowel movements*

0123

I get a sense of fullness during and after meals*

0123

I have difficulty digesting fruits and vegetables; undigested foods found in stools*

0123

I experience stomach pain, burning, or aching 1-4 hours after eating*

0123

I use antacids*

0123

I feel hungry an hour or two after eating*

0123

I experience heartburn when lying down or bending forward*

0123

I experience temporary relief by using antacids, food, milk, or carbonated beverages*

0123

My digestive problems subside with rest and relaxation*

0123

I experience heartburn due to spicy foods, chocolate, citrus, peppers, alcohol, and caffeine*

0123

Eating roughage and fiber cause me constipation*

0123

I experience indigestion and fullness last 2-4 hours after eating*

0123

I experience pain, tenderness, soreness on left side under rib cage*

0123

I expereience excessive passage of gas*

0123

I experience nausea and/or vomiting*

0123

I experience Stool undigested, foul smelling, mucous like, greasy, or poorly formed*

0123

I experience frequent urination*

0123

I experience increased thirst and appetite*

0123

I have difficulty losing weight*

0123
Result
Should be Empty:

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