Simple Quiz

When did your symptoms start?

< 1 year ago

1-5 years ago

10+ years ago

What meds have you been prescribed?

Inhalers

Non-Steroidal Pills (Mesalamine, Hydroxychloroquine, Methotrexate, Gabapentin)

Steroids (Prednisone, IV, Budesonide)

Biologics (Injections, Infusions)

What is your functional status now?

No limitations

Some limitations, (mostly normal)

Moderate restrictions (modified activity)

Severe disability (help needed)

Bed-ridden / Hospitalized (full assistance)

How often do you experience moderate to severe symptoms

Never

Every day

Few days a week

Few days a month

Few days/weeks a year

What additional therapies have you tried?

Encapsulated vitamins + supplements

Herbal Teas

Probiotics

Regenerative Peptides, Stem Cells

Does diet impact severity of symptoms?

No, I’ve tried several diets unsuccessfully

Yes, excluding certain foods helps

Unknown, Never tried, Mixed/inconsistent results

How is your sleep?

Excellent- 7-10 hours of restful, undisturbed sleep each night

Insufficient- 5-7 restful hours, CPAP Apnea

Very bad: Less than 5 hours of restful sleep. Moderate to severe Snoring, apnea untreated.

How much do you currently exercise?

<1 hour per week

2-5 hours per week

6+ hours per week

Name

Email

Lupus

Fatty Liver

Ulcerative Colitis

Candida

Rheumatoid Arthritis

Irritable Bowel Syndrome

Psoriasis

SIBO

Multiple Sclerosis

Crohn's Disease

Eczema

Allergies

Sjögren's Syndrome

Scleroderma

Fibromyalgia