What are you experiencing?
Bloating or visible abdominal swelling
Acidity, heartburn, or burning sensation
Constipation or infrequent stools
Fatigue or heaviness after eating
Frequent colds, infections, or low immunity
Skin issues — acne, rashes, or dullness
None — I'm here for general wellness
Bloating
How often does bloating occur?
A few times a month
2–3 times a week
Almost every day
Daily, with visible abdominal expansion
Bloating
When does bloating typically worsen?
Within 30–90 minutes of eating
1–3 hours after eating
Builds through the day — worst by evening
Persistent all day, not clearly related to meals
Bloating
Where do you feel it most?
Upper
left
Upper
center
Upper
right
Mid
left
Navel
area
Mid
right
Lower
left
Lower
center
Lower
right
Tap all areas that apply
Bloating
Do you get relief after passing stool or gas?
Yes — clearly eases after
Partially — some relief, but it returns
No — bloating persists regardless
Stool Pattern
What does your stool most commonly look like?
🪨
Type 1–2Hard, lumpySlow transit
🌭
Type 3–4Smooth, formedIdeal transit
🍂
Type 5–6Soft, fluffyFast transit
💧
Type 7Watery, liquidVery fast transit
Bloating
Do any of these consistently worsen symptoms?
Wheat, bread, roti
Dairy — milk, paneer, curd
Legumes, dal, or beans
Raw salads or cruciferous vegetables
Onion or garlic
No clear food trigger
Acidity
How often do you experience acidity or heartburn?
Occasionally — a few times a month
Once a week
Multiple times a week
Daily
Acidity
Which description fits you best?
Mild acidity after heavy or spicy meals, settles on its own
Frequent burping, throat irritation, mild burning
Daily nausea, burning even with simple meals
Bitter taste in mouth, feeling of food stuck in throat
Constant reflux, waking at night with burning or chest pain
Acidity
When do symptoms typically occur?
Immediately during or just after eating
30–60 minutes after a meal
1–3 hours after eating, often with bloating too
When lying down, bending over, or at night
Acidity
Does stress noticeably worsen your acidity?
Yes — strong link, clearly worse under stress
Sometimes
No — seems unrelated
Acidity
Are you currently using acid medication?
Yes — PPI regularly (omeprazole, pantoprazole)
Occasional antacid (Eno, Digene, Gelusil)
No medication
Note: Long-term PPI use reduces stomach acid needed for B12 absorption, immune defence, and microbiome balance. Your report will address this specifically.
Constipation
How many bowel movements per week, typically?
5–7 — once daily or more
3–4 times
1–2 times
Less than once a week
Constipation
Which of these apply to your bowel movements?
I strain for more than 5 minutes
I feel incomplete — like there's more but I can't pass it
I need to push or use fingers to help
I rely on laxatives or supplements to go
None of the above
Constipation
Does constipation alternate with loose or urgent stools?
Yes — I swing between both
Occasionally
No — consistently slow/constipated
Constipation
How would you rate your daily water and fibre intake?
Good — 8+ glasses water, plenty of vegetables
Average — some days better than others
Poor — I rarely drink enough or eat enough fibre
Post-Meal Fatigue
How soon after eating do you feel fatigued or heavy?
Within 30 minutes
1–2 hours after meals
Only after unusually large meals
After almost every meal, regardless of size
Post-Meal Fatigue
Which type of meal most reliably triggers it?
High-carb meals — rice, bread, roti, pasta
Sugary foods or sweets
High-fat or fried meals
High-protein meals
No pattern — happens regardless of meal type
Post-Meal Fatigue
Rate your average daily energy level.
Immunity
How often have you fallen ill in the past 12 months?
Rarely — once or never
2–3 times
Every season — about 4 times
Monthly or more
Immunity
Antibiotic courses in the past 12 months?
None
1–2 courses
3 or more courses
Skin & Gut
What type of skin concern are you experiencing?
Acne or breakouts — especially on jaw or cheeks
Eczema, psoriasis, or chronic rashes
Dull, dry, or uneven skin tone
Skin worsens when stressed or after certain foods
Context
How long have you had these concerns?
Less than 3 months
3–12 months
1–5 years
More than 5 years
Context
How would you describe your current stress level?
Low — generally calm and managed
Moderate — present but manageable
High — frequently overwhelmed or anxious
Context
How would you describe your sleep quality?
Deep and generally uninterrupted
Light sleep, wake occasionally
Frequently disrupted — rarely feel rested
Context
Which best describes your current diet?
Mostly home-cooked, vegetables, whole grains
Mixed — some home food, some outside food
Irregular meals — skip breakfast, eat late
High in processed, fried, or packaged food
Lifestyle
Daily caffeine intake?
None
1–2 coffees or teas
3 or more
Alcohol frequency?
Never
Occasional
Weekly or more
Dietary
Any known food allergies or restrictions?
Tree nuts
Soy
Gluten / Wheat
Dairy / Lactose
Shellfish
No known allergies
We will make sure none of these are included in your formulation or recommendations.
Medical History
Any existing diagnoses?
IBS (Irritable Bowel Syndrome)
IBD (Crohn's / Ulcerative Colitis)
Thyroid disorder
PCOS
Diabetes or Prediabetes
None of the above
Analyzing your profile
- Mapping your symptom patterns
- Identifying root cause mechanisms
- Scoring gut-brain axis factors
- Building your personalized report
This assessment is for informational purposes only and does not constitute a medical diagnosis. Consult a healthcare professional for persistent or severe symptoms.
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