skip to Main Content

CALL 1.800.996.0610

Menu

How it works
Natural Supplements
FAQ
Contact Us

CALL 1.800.996.0610

Menu

How it works
Natural Supplements
FAQ
Contact Us

Lower Gut Questionnaire

Home » Lower Gut Questionnaire

Lower Gut Questionnaire

Lower Gut Questionnaire

Step 1 of 5

20%

Leaky gut is when the barrier of your intestinal wall isn’t working and undigested food gets into your bloodstream, which causes an immune and inflammatory reaction throughout your body.

1. Constipation and/or diarrhea(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

2. Abdominal pain or bloating(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

3. Mucous or blood in stool(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

4. Joint pain or swelling, arthritis(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

5. Chronic or frequent fatigue or tiredness(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

6. Food allergies, sensitivities or intolerance(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

7. Sinus or nasal congestion(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

8. Chronic or frequent inflammations(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

9. Eczema, skin rashes or hives (urticaria)(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

10. Asthma, hayfever, or airborne allergies(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

11. Confusion, poor memory or mood swings(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

12. Use of NSAIDS (Aspirin, Tylenol, Motrin)(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

13. History of antibiotic use(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

14. Alcohol consumption makes you feel sick(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

15. Ulcerative colitis, Crohn's or Coeliacs disease(Required)

Symptom is not present or rarely present

Mild/sometimes

Moderate/often

Severe/almost always

Name(Required)

First Last

Email(Required)

Phone(Required)

Date(Required)

MM slash DD slash YYYY

CAPTCHA

MEET THE DOCTORS
HOW IT WORKS
NATURAL SUPPLEMENTS
HORMONE OPTIMIZATION
FAQ
CONTACT

Privacy Notice
Terms and Conditions
Privacy Policy
SMS Policy

Copyright © 2023. All rights reserved. | Managed by LC Media Agency

Home
How Does AlfaGenix Work?
Supplements
Hormone Optimization
Blog
FAQ
Contact Us
Partners

Search