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Are you:

Male

Female

Neither

What digestive issue challenges you the most?

Heartburn

Gas & Bloating

Constipation & Regularity

When does it occur?

Less than 30 minutes after eating.

Between 30 mins - 2 hours after eating.

My heartburn occurs on an empty stomach and/or wakes me up in the middle of the night.

Only after eating specific foods.

When does it occur?

Less than 30 minutes after eating.

Between 30 minutes - 2 hours after eating.

All the time.

Only after eating specific foods.

Which most directly applies to you?

I have an occasional loose stool.

I have less than one bowel movement per day.

I have hard, difficult-to-pass stools.

I have alternating diarrhea and constipation.

Select all that apply to you.

I have weak, peeling or cracked nails.

My immune system needs extra support.

I need to rebuild my digestive tract.

I have a food intolerance (lactose, gluten, etc.).

I only get heartburn from specific foods.

None.

Which applies to you?

My heartburn is responsive to antacids or acid-blocking drugs, but I want something natural.

My waist is larger than my hips.

I'm pregnant.

None.

Which applies to you?

I need to repair my digestive system.

The pain from heartburn is relieved by antacids or acid-blocking drugs.

I feel full easily.

I have a history of taking pain killers.

Sometimes I feel stomach pressure.

Drinking milk or eating food gives me relief.

None.

Which foods trigger your heartburn?

Alcohol

High-fat foods

Coffee/chocolate

Acidic foods like citrus or tomatoes

Spicy foods

Salty foods

Other foods

empty

Which applies to you?

I typically eat small meals.

I typically eat medium-sized meals.

I typically eat large meals.

Which applies to you?

My gas and bloating are lessened with a bowel movement.

My gas and bloating are not lessened by a normal bowel movement.

I'm constipated, and bowel movements have no impact on my gas and bloating.

My bowel movements are not well-formed.

Which best describes your diet?

Standard diet

Vegan

Paleo, zone, pescatarian or low carb

Keto

Select all foods that trigger gas and bloating.

Dairy

Bread, pasta, wheat and grains

Legumes (beans, lentils, etc.)

Veggies

Fats and oils

Other foods

Which best describes your diet?

Standard diet

Vegan

Paleo, zone, pescatarian or low carb

Keto

Which best describes your diet?

Standard diet

Vegan

Paleo, zone, pescatarian or low carb

Keto

Which best describes your diet?

Standard diet

Vegan

Paleo, zone, pescatarian or low carb

Keto

Which best describes your diet?

Standard diet

Vegan

Paleo, zone, pescatarian or low carb

Keto

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