Your Starting Point Name * First Name Last Name Email Your baseline How How long have you been struggling with gut issues? * Less than 1 year 1-5 years More than 5 years How severe are your current gut symptoms? * 1 = no symptoms, 10 = extreme 1 2 3 4 5 6 7 8 9 10 How often do your symptoms interfere with your daily life? * 1 = not at all, 10 = daily 1 2 3 4 5 6 7 8 9 10 How frustrated are you about your gut symptoms? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 Describe your gut symptoms in your own words How confident are you in understanding what’s going on in your gut? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 How confident are you in knowing what to do when symptoms arise? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 How confident are you in making nutrition choices to support your gut? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 The bigger picture How much do your gut symptoms impact your energy levels? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 How much do your gut symptoms impact your social or work life? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 How much do your gut symptoms impact your mood or mental wellbeing? * 1 = not at all, 10 = extremely 1 2 3 4 5 6 7 8 9 10 How do your gut symptoms make you feel on a day-to-day basis? Thank you! *Screenshot this page before pressing submit to keep a copy of your answers !
