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Gut & Digestive Health Questionnaire Form

Run a focused digestive-health intake for nutritional therapists, capturing symptoms, triggers, and their impact in one form.

Description

The Gut and Digestive Health Questionnaire Form gives nutritional therapists a focused way to understand a client’s digestive health. It captures which symptoms they experience, how often, and how their bowel movements typically are, so you build a clear picture of what is going on before advising.

Fields for when issues began, food triggers, recent antibiotic use, stress levels, and how much symptoms affect daily life complete a thorough intake, while a consent step covers the sensitive information involved. Capturing all this upfront lets you support each client thoughtfully and safely.

A focused intake leads to focused support. Sign up for a free Fun Forms account to customize the fields and embed this questionnaire on your website.

Form fields

Everything the Gut & Digestive Health Questionnaire Form above collects — 13 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Your Gut Health

  • Which symptoms do you experience?

    Multi-Select Icon
    Multi-Select
  • How often do these occur?

    Dropdown Icon
    Dropdown
  • How are your bowel movements, typically?

    Dropdown Icon
    Dropdown
  • When did you first notice these issues?

    Long Answer Icon
    Long Answer
  • Do certain foods clearly trigger symptoms?

    Yes/No Icon
    Yes/No
  • If yes, which foods?

    Long Answer Icon
    Long Answer
  • Have you taken antibiotics in the last year?

    Yes/No Icon
    Yes/No
  • How would you rate your stress levels?

    Dropdown Icon
    Dropdown
  • How much do these symptoms affect your daily life?

    Scale Icon
    Scale

About You

  • Your name

    Name Icon
    Name
  • Email address

    Email Icon
    Email
  • Date of birth

    Date Icon
    Date
  • Consent

    Consent Icon
    Consent
Use Template Arrow Right Icon

Template FAQs

Common questions about the Gut & Digestive Health Questionnaire Form — what it captures, when to use it, and how to make it your own.

What is a gut and digestive health questionnaire form?

A gut and digestive health questionnaire form is an online form clients use to share their digestive symptoms and history. It captures symptoms, triggers, and impact, so a nutritional therapist can understand what is going on and support the client thoughtfully and safely through diet.

Why ask about recent antibiotic use?

Antibiotics can significantly affect gut bacteria and digestion, so recent use is important context. Capturing it helps you understand possible contributors to a client’s symptoms and tailor your dietary support accordingly, without giving medical advice, as part of building a complete picture of their gut health.

Why ask about stress levels?

Stress and digestion are closely linked through the gut-brain connection, so stress levels are relevant context for many digestive issues. Capturing them helps you understand the whole picture and consider lifestyle alongside diet, so your support addresses the real drivers of a client’s symptoms.

Why ask how symptoms affect daily life?

Knowing how much symptoms affect daily life reveals their real impact and helps you prioritize. Someone whose life is significantly disrupted needs focused, sensitive support, so understanding this ensures you respond appropriately and take their experience seriously rather than treating it as minor.

Why include a consent step?

Digestive health information is sensitive personal data, so a consent step ensures the client agrees to how it will be used. It supports responsible handling of the information and gives you a clear, recorded acknowledgment as you begin working together on their gut health.

Is the gut and digestive health questionnaire form free?

Yes, this gut and digestive health questionnaire form is completely free, and you can customize the fields to fit your practice, embed it on your website, and go live with no coding required. Just create a free Fun Forms account to start onboarding clients online.