Please select NOW if you're currently dealing with the condition, or PREVIOUSLY if you've experienced it in the past.
If neither apply, choose NEVER.

Anorexia Nervosa ..... 

Belching ..... 

Bulimia ..... 

Bowel Habit Change ..... 

Crohn's Disease ..... 

Constipation ..... 

Diarrhea ..... 

Dysentery ..... 

Eating Disorders ..... 

Flatulence ..... 
Food Unappetizing ..... 

Gallstones ..... 

Heartburn ..... 

Hemorrhoids ..... 

Irritable Bowel Syndrome ..... 

Diverticulitis ..... 

Large Appetite ..... 

Liver Problems ..... 

Low Appetite ..... 

Nausea ..... 

Pain After Eating ..... 

Stomach Aches ..... 

Sudden Weight Change ..... 

Ulcer ..... 

Ulcerative Colitis ..... 

Vomiting ..... 

Indigestion ..... 

Parasites ..... 

Other ..... 

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Allergies ..... 

Autoimmune Disorders ..... 

Catch Everything ..... 
Chronic Fatigue ..... 

Enlarged Spleen ..... 

Hashimoto's Thyroiditis ..... 

Heal Slowly ..... 

Immunodefocoency ..... 

Infections ..... 

Lowered Resistance ..... 

Lupus ..... 

Mononucleosis ..... 

Rheumatoid Arthritis ..... 

Sick Often ..... 

Sore Throats ..... 

Swollen Lymph Glands ..... 

White Blood Cell Count ..... 

Other ..... 

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