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01
When does bloating typically occur?
Within 30–90 minutes after eating
Hours after eating, or in the afternoon/evening
Unpredictable, no clear pattern with meals
Rarely or never bloat
How would you describe the bloating sensation?
Visibly distended abdomen, feels like a balloon
Gassy pressure, not visually obvious
General fullness or sluggishness
Minimal or no bloating
Does eating more fiber or vegetables make bloating significantly worse?
Yes, significantly worse
Somewhat, certain vegetables bother me
No, fiber has no effect
I don't eat much fiber, hard to tell
02
What is your typical bowel pattern?
Alternating constipation and diarrhea
Predominantly constipated (fewer than 1x/day)
Predominantly loose stools or frequent urgency
Inconsistent with no predictable pattern
Regular, once or twice daily, well-formed
Do you notice undigested food in your stool?
Yes, frequently
Occasionally
Rarely or never
How would you describe stool consistency most days?
Bristol Scale: Type 1–2 = hard/lumpy, Type 3–4 = normal, Type 5–7 = soft/liquid
Hard, pellet-like, difficult to pass (Type 1–2)
Well-formed, smooth (Type 3–4)
Soft, mushy, or watery (Type 5–7)
Varies significantly day to day
03
Where is abdominal pain or discomfort most commonly felt? (Select all that apply)
Upper abdomen or around the belly button
Lower abdomen, cramping lower left or right
Diffuse or generalized, hard to pinpoint
No significant abdominal pain
Does discomfort improve after passing gas or a bowel movement?
Yes, reliably better after a bowel movement
Somewhat, temporarily relieved by passing gas
No, it persists regardless
I don't have significant discomfort
Rate your average daily abdominal pain or discomfort
NoneMildModerateSevere
0 / 10
04
Which foods most consistently trigger your symptoms? (Select all that apply)
Fermented foods (yogurt, kimchi, sauerkraut, kombucha)
High-FODMAP foods (garlic, onion, beans, apples, wheat)
Prebiotic foods (asparagus, leeks, artichokes, oats)
Gluten (bread, pasta, most packaged foods)
Dairy (milk, cheese, ice cream)
Multiple foods in an unpredictable way
No specific food triggers
Have you developed new food sensitivities or intolerances in the past 1–3 years?
Yes, multiple new sensitivities have developed
One or two new sensitivities
No, sensitivities have been consistent long-term
No food sensitivities at all
Do symptoms dramatically improve when you eat less or fast?
Yes, fasting or very small meals dramatically reduce symptoms
Somewhat, large meals are clearly worse
No, meal size doesn't seem to matter
05
Do you experience any of the following? (Select all that apply)
Skin issues: eczema, psoriasis, rosacea, chronic acne
Joint pain or stiffness not explained by injury
Diagnosed or suspected autoimmune condition
Chronic fatigue that doesn't improve with sleep
Frequent colds or immune issues
Seasonal or environmental allergies (new or worsening)
None of the above
Do you experience brain fog, difficulty concentrating, or mood changes?
Yes, significant and correlates with gut symptoms
Yes, but doesn't seem related to gut symptoms
Occasionally, mild
Rarely or never
Do you have or suspect any of the following? (Select all that apply)
Hashimoto's thyroiditis or hypothyroidism
Rheumatoid arthritis or other inflammatory arthritis
Celiac disease or strong gluten sensitivity
IBS diagnosis confirmed by a doctor
SIBO previously diagnosed
None of these apply
06
Have you taken antibiotics in the last 2 years?
Yes, multiple courses
Yes, one course
No
Do you take or have you taken any of the following? (Select all that apply)
Proton pump inhibitors or acid blockers (Prilosec, Nexium, Pepcid)
NSAIDs regularly (ibuprofen, naproxen, aspirin)
Oral corticosteroids (prednisone)
Narcotics or opioids (can slow gut motility)
None of these
Did your gut symptoms begin or worsen after a specific event?
After a GI illness, food poisoning, or traveler's diarrhea
After a course of antibiotics
After a period of high stress or trauma
Gradually over time, no clear trigger
I've always had gut issues as far back as I remember
How would you describe your diet over the past year?
High in processed foods, refined carbs, alcohol, or sugar
Moderate processed foods, inconsistent eating habits
Whole foods focused, minimal processed foods
Very high in fiber and fermented foods trying to be healthy
07
Have you experienced any of the following? (Select all that apply)
Low B12 or iron despite eating meat or supplementing
Low Vitamin D despite supplementation
Unexplained weight loss or difficulty gaining weight
Hair thinning or brittle nails
Pale or greasy stools
No nutritional deficiencies or absorption issues
Do you experience excessive burping or belching after meals?
Yes, frequently and often a lot
Sometimes, more than average
Normal amount or rarely
Do you experience acid reflux, heartburn, or GERD symptoms?
Yes, frequently (multiple times per week)
Occasionally
Rarely or never
08
Rate your chronic stress level
Very LowModerateExtreme
0 / 10
How is your sleep quality?
Poor, consistently under 6 hours or unrestorative
Inconsistent, some good nights some bad
Generally good, 7+ hours most nights
How much alcohol do you consume weekly?
14+ drinks per week
7–13 drinks per week
1–6 drinks per week
Rarely or never
How would you describe your exercise habits?
Consistent, 3–5x per week
Sporadic or minimal
Sedentary, little to no exercise
Very high volume (endurance athlete, daily intense training)
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YOUR GUT
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Based on your symptom pattern, here is what your body may be signaling. This is probability-based guidance, not a diagnosis.

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Important: This assessment is for educational purposes only and is not a substitute for medical evaluation. SIBO requires a breath test for confirmation. Increased intestinal permeability is assessed through specific lab markers. Work with a functional medicine physician, gastroenterologist, or integrative health practitioner to confirm any findings and build an appropriate protocol.