Prexnova - LEVEL 7 Quiz

Digestive Issues Questionnaire Questions

First Name *

Last Name *

Phone *

Date of birth *

Email *

Privacy Notice & Client Consent

I understand that the information I provide in this consultation is personal health information and will be used solely for the purpose of guiding natural-health recommendations and support.
This information will be kept confidential and protected according to HIPAA privacy and security standards.

Privacy Consent *

I consent to the collection and use of my information as described above.

Compliance Notice

This quiz is for educational and wellness-support purposes only. It does not diagnose or treat medical conditions. Responses may be reviewed by a licensed provider to determine eligibility for a doctor-guided protocol. Individual results may vary.

Question 1

Which of the following best describes the digestive issue causing you the most trouble? *

Irregular bowel movements (constipation or diarrhea)

Persistent bloating or fullness after meals

Cramping or abdominal pain

Reflux, nausea or burning sensation

Slowed digestion or “heavy stomach” sensation (often seen with GLP-1–type medications)

Other

Question 2

How long have you been experiencing these digestive issues? *

Less than 3 months

3–12 months

1–3 years

Over 3 years

Question 3

How often do your digestive symptoms interfere with daily life? *

Every day, multiple times

Several times per week

A few times a month

Occasionally only after certain foods

Question 4

What have you already tried to improve digestion? *

Prescription or OTC medications (antacids, laxatives, etc.)

Probiotics or digestive enzymes

CBD or herbal / natural remedies

Diet changes (low-FODMAP, dairy-free, gluten-free, etc.)

Nothing has worked

Other

Question 5

Which part of your life has been most affected by your digestion? *

Question 6

When do your digestive issues tend to flare up most? *

Question 7

What do you believe affects your digestion the most? *

Stress or emotional strain

Food sensitivities or intolerances

Gut bacteria imbalance (microbiome issues)

Hormonal or metabolic factors

Not sure — nothing seems to help

Question 8

If your digestion improved significantly in the next 30 days, what outcome would mean the most to you? *

Eating freely without discomfort

Consistent, easy digestion and bowel regularity

Waking up lighter and less bloated

Having steady daily energy and focus

Confidence that my gut is finally working properly

Question 9

Many clients use commercial insurance to reduce the cost of this doctor protocol. Do you currently have coverage through an employer or private plan? *

Yes — I have commercial insurance (BCBS, Aetna, Cigna, etc.)

HSA/FSA/Self-Pay Cash