Digestion Questionnaire

Digestive Capacity Assessment (FREE)

Are you having problems with your digestion? Most people do and fixing this issue will likely be a life changing experience!! Try out this questionnaire and discover whether your digestive system is truly working as it should be.

If you answer yes to two or more of these questions, you will likely need to take action in order to get your digestion back on track.
If you answer yes to three or more of these questions, taking action to fix your digestion will likely change your life.

Mark will review your answers and get back to you with some feedback via your email as soon as he can.

Please answer the questions below and click the submit button

* Indicates required field

Name *

First

Last

Email *

Phone Number: *

Which country do you live in? *

Which Town / City? *

Keep Informed? *

Please keep me up to date with announcements, newsletters, programs etc.

On a scale of 1 - 10 how do you rate your health and vitality right now? (1 being flat on your back, 10 being walking on air). *

If I were a magician (which I'm not) and could wave a magic wand to grant you ONE wish relating to improving your health, what would you wish for? *

Do you frequently pass gas after meals? *

Do you often burp after meals or feel bloated? (Even just small burps.) *

Does your meal ever feel like it's sitting in your stomach like a rock for too long? *

Do you crave sweet or salty foods? *

Do some foods make you nauseous? *

Is your stool sometimes lighter than the colour of corrugated cardboard? *

Do you ever experience heartburn or acid reflux *

Have you recently taken any antacids or acid reflux medications? *

Are you frequently constipated? *

Do you frequently experience diarrhoea or a loose stool? *

Do you ever see undigested food in your stool? *

Do you seem to gain weight no matter what you eat? *

Do cravings frequently derail your weight loss attempts? *

Do you have a stomach ulcer? *

Have you had your gallbladder removed? *

Are you on any medications? If so, please note here ... *

Submit

﻿Digestive Capacity Assessment (FREE)﻿

Please answer the questions below and click the submit button

Digestive Capacity Assessment (FREE)