Page 1 of 5...Know Your Gut Type

I experience bloating or gas after eating certain foods *

I experience a burning sensation or acidity in the stomach after meals *

My appetite fluctuates, from feeling very hungry to not at all *

I experience heartburn or acid reflux after spicy or heavy meals *

I feel heat or burning in my stomach, especially when stressed *

I feel full or heavy in my stomach, even after eating a small meal *

Page 2 of 5...Know Your Gut Type

It’s usual for me to have a low appetite or feel indifferent about food *

I experience pain or discomfort in the mid- lower abdomen (from naval point to below) *

I experience loose stools or diarrhea, especially after consuming fatty or rich foods *

I feel sluggish or heavy after eating a large meal *

My digestion is slow as I feel full for an extended period after meals *

I experience bloating and heaviness in the abdomen after even light meals *

P3 of 5...Know Your Gut Type

My bowel movements are erratic, from multiple times a day to none at all *

I experience an urge to defecate shortly after eating certain foods *

I experience an urge to defecate with loose stools shortly after eating certain foods *

I notice oily or greasy stools, particularly after eating rich, fried foods *

I sometimes feel constipated, with hard and dry stools that are difficult to pass *

I experience constipation regularly *

Page 4 of 5...Gut Health Score

I’ve experienced changes in my bowel habits recently *

I’ve an increased sensitivity to certain foods compared to before *

No
Yes, with mild discomfort
Yes, with moderate discomfort
Yes, with Severe discomfort

I frequently experience discomfort after meals *

No
Yes, with mild discomfort
Yes, with moderate discomfort
Yes, with Severe discomfort

I’ve an unusual pattern in my bowel movement (e.g. very loose, or hard and dry) *

No
Yes, with mild discomfort
Yes, with moderate discomfort
Yes, with Severe discomfort

I’ve known gut disorder/s (e.g. Bloating, IBS, Acidity et al.) *

I’ve other health disorders ( e.g. Diabetes, Hypertension, Chronic pain et al.) *

Page 5 of 5...Gut Health Score

How many hours of sleep do you get per night? *

Do you wake up frequently during the night? *

What time do you usually go to bed? *

Before 10pm
10pm midnight
After Midnight

Do you often feel stressed or anxious? *

How would you rate your stress level? *

No
Yes, with mild stress
Yes, with moderate stress
Yes, with Severe stress

Do you crave specific types of food? (sweet, salty spicy etc.) *

Do you smoke or use tobacco products? *

If Yes, how often?

Occasionally
Daily
Multiple times daily

Do you consume alcohol? *

If Yes, how often?

Occasionally
Weekly
Daily

Have you used recreational drugs? *

Page 6...Your medical history:

Are you currently taking any medications for digestive health conditions? *

Have you undergone any surgeries? *

Upload medical report / prescriptions ( previous / recent )

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