What is your biggest challenge with your IBS right now? *

What would success look like for you 2 months from now? *

Anything else you’d like me to know about your IBS? *

What do you think or feel is the root cause of your IBS? *

In the PAST MONTH, 30 minutes after eating a meal, how often have felt bloated in your abdomen? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you felt bloated in other parts of your body? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you suffered from indigestion? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you suffered from diarrhoea? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you been constipated? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you experienced heartburn? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you had excessive gas/flatulence? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you felt fatigued? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you suffered from skin irritation after eating? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you been burping excessively? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you experienced stomach cramps? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you experienced flu-like symptoms? *

• Less than ONCE a week
• 1 to 3 times a week
• 4 to 6 Times a week
• 7 or More times a week
• No elements found. Consider changing the search query.
• List is empty.

In the PAST MONTH, 30 minutes after eating a meal, how often have you felt generally worse after eating than you did before eating? *

• Less than ONCE a week
• 1 to 3 Times a week
• 4 to 6 Times a week
• 7 or MORE times a week
• No elements found. Consider changing the search query.
• List is empty.

How do you generally feel shortly after a meal? Do you experience any discomforts, such as an upset stomach, or abdominal cramping? Try to describe how you feel 30 minutes after a meal. *

How do you generally feel, 2 hours after a meal? are symptom severity increased, diminished, or similar? *

Do you find that your bowel movements are sometime irregular, or you frequently suffer from diarrhoea or constipation? *

Do you suffer adverse effects from specific kinds of meals? for example, do you feel bloated or uncomfortable when consuming foods containing dairy? List any example you can think of. *

Do you suffer from external, visible symptoms, such as rashes or skin irritation, shortly after eating ( a few minutes)? if so, detail them below *

Do you ever feel fatigue shortly ( a few minutes ) after eating a meal? for how long does this effect last? *

Does your discomfort interfere with your productivity? for example, does it reduce your sleep quality, or impact on your work output? List any situations where you feel you discomfort has had a negative consequence. *

Does your discomfort interfere with your social life? for example, do you feel uncomfortable that people notice your discomfort, which leads to an avoidance of social situations? *

Full Name *

Email *

Phone *

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