Please place a checkmark by the statements that apply to you:

(NOTE: This questionnaire is not a substitute for formal diagnosis by a medical professional)

When I eat, the food seems to sit in my stomach for a long time.

I often feel bloating, pain, or discomfort within 20 minutes of eating.

I feel abdominal pain or discomfort 30-60 minutes after eating.

I feel bloating, pain or discomfort more than 60 minutes after eating.

I frequently burp or have heartburn.

I feel pain right below my ribcage on the right side after eating--especially with fatty meals.

I often don't know when I'll need to have an urgent bowel movement.

My bowel movements are often unformed, loose, or watery.

I often have 4 or more bowel movements a day.

I don't have a bowel movement every day, or my stools are hard to pass.

I take fiber or magnesium or a laxative to help with bowel movements.

My stool consistency varies: some are normal, some days hard, some days loose.

My gut seems to react badly to certain foods, but I can't find all the triggers.

My digestion is strongly affected by my stress level.

Females: My gut function is strongly affected by my menstrual cycle.

I have been diagnosed with IBS.

I frequently take pepto-bismol or antacids to soothe my gut.

I am taking an acid blocker (Nexium, Prilosec, Pepcid-AC, Prevacid, etc.)

Probiotics have improved my gut function some.

Probiotics seemed to make my gut symptoms worse.

My digestive issues started after I traveled, or had a GI infection.

I have been diagnosed with IBD (Chrohn's disease or ulcerative colitis)

I have celiac disease or gluten insensitivity.

I have a first degree relative with celiac disease or gluten intolerance.

If I do not drink coffee, i get constipated.

I have a history of ulcers in my stomach or duodenum (proximal small intestine)

I have a family history of colon cancer.

I suspect that I have a candida overgrowth in my gut.

I have oral thrush (candida) in my mouth or tongue.

I have another concern about my GI tract that was not listed above.