FODMAP Intensive Strategy Session
Hi friend! I'm so excited to join you in this FREE strategy session! Thanks in advance for filling out this survey! Your answers will help me get to know you and your situation a little better, so we can focus our time on building a plan to get you where you want to be! All of your answers will be kept strictly confidential!
What do you hope to achieve together over the next 16 weeks?
What have you tried in the past to accomplish this goal?
What has worked so far?
What obstacles or challenges have you experienced trying to reach your goal on your own?
Why would you like to try the low FODMAP diet?
Please describe your average diet <- Heads up, this is a judgement-free zone!! Please be specific and list your typical breakfast, lunch, dinner, snacks, etc. and what time they're normally eaten.
Do you have any existing conditions, dietary needs, or instructions from your healthcare team we'll need to take into consideration when designing your customized plan?
Are you taking any probiotics, supplements, or medications? If so, what do they do?
On a scale of 1 - 100 (where 1 is no symptoms and 100 is the worst possible symptoms) please list and rate your TOP THREE symptoms on a scale of 1 - 100 (ex. bloating 70/100, diarrhea 90/100, gas 40/100)
Have you ever experienced:
A fever during a flare
A rash on your skin during or after a flare
Unexplained weight loss
Unexplained joint pain
Blood in your stool
Continuous burping or gas
Bowel movements that wake you up at night
Frequent or severe watery diarrhea
No, none of these
What are five things you LOVE about your life?
Send me a copy of my responses.
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