Initial Symptoms Survey

Step 1 of 15

  • Please complete this form in one sitting. Incomplete forms cannot be saved.

  • Digestive Tract

    Rate each of the following symptoms based upon your typical health profile for the past 30 days. Point Scale: 0 – Never (0 days per month) 1 – Sometimes (1-5 days per month) 2 – Occasionally (5-7 days per month) 3 – Frequently (7-10 days per month) 4 – Often (10+ days per month)
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