Gut Health Quiz

Name *

First Name

Last Name

Do you frequently experience bloating, especially after meals?

Yes

No

Sometimes

Do you suffer from chronic gas, belching, or abdominal discomfort?

Yes, Often

Yes, Occasionally

Rarely

Never

Do you notice undigested food, mucus or oily residue in your stool?

Yes

No

Sometimes

Do you crave sugar, carbs or processed foods frequently?

Yes

Sometimes

Rarely

Never

Do you experience skin issues (rashes, acne, eczema) that haven't resolved with topical products?

Yes

No

Occasionally

Do you take acid blocking medications (like PPI's or antacids) regularly?

Yes

No

Do you consume alcohol, caffeine or processed foods more than three times a week?

Yes

No

Sometimes

Do you often skip meals, eat too fast or eat while distracted (phone, TV, etc)?

Yes

No

Do you get sick easily or struggle with slow recovery from illness?

Yes

No

Sometimes

What kind of support or next step would be most helpful for you right now?

I'd love a simple breakdown of my results and a few tips to get started.

I'm curious about working one on one and want to learn more about your coaching.

I'm just exploring for now, thanks for the info.