Gut Check Δ Step 1 of 6 - Start 0% Name(Required) First Last Email (results are sent to provided email)(Required) Enter Email Confirm Email CAPTCHA How often do you experience bloating or abdominal discomfort?(Required) Never Rarely Sometimes Often Always How frequently do you have issues with constipation or diarrhea?(Required) Never Rarely Sometimes Often Always How often do you experience acid reflux, indigestion, or GERD?(Required) Never Rarely Sometimes Often Always How often do you experience excessive belching while eating?(Required) Never Rarely Sometimes Often Always How often do you experience increased flatulence?(Required) Never Rarely Sometimes Often Always Do you experience any intestinal bleeding?(Required) Never Rarely Sometimes Often Always How frequently do you experience symptoms of hemorrhoids?(Required) Never Rarely Sometimes Often Always Do you have trouble with fatty meals?(Required) Never Rarely Sometimes Often Always Do you find it difficult to digest meat?(Required) Never Rarely Sometimes Often Always How often do you see undigested food in your stool?(Required) Never Rarely Sometimes Often Always Which of the following best describes your diet?(Required) Balanced Paleo Vegetarian Vegan Carnivore Keto High in Processed Foods How often do you notice that certain foods consistently cause digestive discomfort?(Required) Never Rarely Sometimes Often Always On average, how many hours of sleep do you get per night?(Required) 7-8 5-6 More than 8 Less than 5 How would you rate your current stress level?(Required) Low Moderate High Very High How often do you engage in physical activity?(Required) Very Active (Daily exercise) Moderately Active (Exercise 3-5 times a week) Lightly Active (Exercise 1-2 times a week) Rarely Active (Occasional exercise) Inactive (No regular exercise) What type of physical activity do you primarily engage in?(Required) Mixed (Cardio x Strength Training) Cardio (Running, Tennis, Pickleball etc.) Strength Training (Weightlifting, etc.) Flexibility (Yoga, etc.) None Have you been diagnosed with any of the following condition(s)? (select all that apply)(Required) None IBS Crohn's Disease Ulcerative Colitis Celiac Disease Lupus Fibromyalgia Rheumatoid Arthritis Scleroderma Hashimoto's This field is hidden when viewing the formQ17 TotalAre you currently taking any medications for health issues?(Required) Yes No Which of the following symptom(s) do you experience most frequently? (select all that apply)(Required) None General Body Aches Excessive Itching Skin Conditions (Eczema, Psoriasis, etc.) Adult Acne Hives Allergies or Asthma Sinus Issues Joint Pains Irregular Periods Hot Flashes or PMS Excessive Breast Tenderness ADD/ADHD Depression Anxiety Recurrent UTI's Recurrent Yeast Infections This field is hidden when viewing the formQ19 TotalRelated to the previous question, how often do you experience these symptom(s)?(Required) Never Rarely Sometimes Often Always What is your primary health goal?(Required) Optimize for Longevity Maintain Current Health Increase Energy Levels Improve Gut-Health Address Chronic Health Conditions Are you interested in natural and holistic treatments for gut health?(Required) Yes Maybe No Do you follow any specific dietary preference?(Required) None Gluten-Free Dairy-Free Low FODMAP Paleo Have you been tested for food intolerances or allergies?(Required) No Yes Do you wake up feeling rested?(Required) Always Often Sometimes Rarely Never Do you have trouble falling asleep or staying asleep?(Required) Never Rarely Sometimes Often Always How often do you feel anxious or overwhelmed?(Required) Never Rarely Sometimes Often Always How do you usually manage levels of elevated stress?(Required) Exercise Meditation Talking to Friends/Family Hobbies How would you rate your overall digestive health?(Required) Excellent Good Fair Poor How frequently do you have a bowel movement?(Required) Once a Day Multiple Times Per Day Every Other Day Few Times Per Week Rarely This field is hidden when viewing the formTotal ScoreConsent & Acknowledgment(Required) I’m 18+ and consent to The Gut Connection processing my answers to email my “Gut Check” results. I understand this is general wellness information, not medical advice, and I agree to the Terms and Privacy Policy. Terms: thegutconnection.com/terms Privacy: thegutconnection.com/privacy Request data deletion: thegutconnection@gmail.com