Do you experience ulcers?

Yes

No

Not Sure

Do you suffer from gastritis (inflammation in the lining of stomach)?

Never

1-2 times per month

Weekly

Daily

Do you experience belching?

Never

1-2 times per month

Weekly

Daily

Do you suffer from bloating (with or without food)?

Never

1-2 times per month

Weekly

Daily

Do you experience nausea and vomiting?

Never

1-2 times per month

Weekly

Daily

Do you suffer from abdominal discomfort?

Never

1-2 times per month

Weekly

Daily

Do you experience abdominal pain?

Never

1-2 Times per Month

Weekly

Daily

Do you suffer from fatigue?

Never

1-2 times per month

Weekly

Daily

Do you experience the passing of dark or tarry like stools?

Never

1-2 times per month

Weekly

Daily

Do you suffer from low red blood cell count (anemia)?

Yes

No

Not sure

Do you experience a decreased appetite?

Never

1-2 times per month

Weekly

Daily

Is it difficult to digest meat/protein?

Yes

No

Do you experience diarrhea?

Never

1-2 times per month

Weekly

Daily

Do you suffer from heart burn?

Never

1-2 Times Per Month

Weekly

Daily

Do you experience bad breath?

Never

1-2 Times Per Month

Weekly

Daily

Do you suffer from low b-vitamins, zinc, iron, calcium, and other micronutrients?

Yes

No

Not sure

First Name *

Email *

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