Digestion Survey

  1. Home
  2. Digestion Survey

Digestion Survey

Many ailments and their symptoms can be traced directly to something in our diet. It is not normal to suffer from low-grade pain, skin disorders, bloating, indigestion, low energy, brain fog, joint pain or any other symptoms that people “live with” after a meal.

By taking this survey, you are helping us learn more about the nature and frequency of digestive distress after eating, what it says about our industrialized food supply, and the effects it can have on us.

Please fill out the survey below to receive a $5 discount coupon for DigestShield®.

    [f12_captcha f12_captcha-719 captcha:math]

    1. Do you suffer from digestive distress?

    YesNo

    If yes, please tell us what type of digestive distress you experience and how often it happens:

    2. Do you take any enzyme supplements?

    YesNo

    If yes, what type?

    3. Do you take any probiotic supplements?

    YesNo

    If yes, what type?

    4. Please briefly describe your eating habits.

    How much of what you eat in a week is processed food?

    10%25%50%75%100%

    5. Rate your current digestive response after eating.

    Indigestion/Heartburn:

    Gas/Bloating:

    Bowel regularity:

    Bowel movement consistency:

    Briefly tell us what a digestive aid needs to do for you in the Comments box below.

    We will send your Discount Coupon after we receive your Survey results. Thank You!

    Your Name

    Your Email (To receive Discount Coupon)

      1. Afrikaans
      2. Albanian
      3. Arabic
      4. Armenian
      5. Azerbaijani
      6. Basque
      7. Belarusian
      8. Bulgarian
      9. Catalan
      10. Chinese (Simplified)
      11. Chinese (Traditional)
      12. Croatian
      13. Czech
      14. Danish
      15. Dutch
      16. English
      17. Estonian
      18. Filipino
      19. Finnish
      20. French
      21. Galician
      22. Georgian
      23. German
      24. Greek
      25. Haitian Creole
      26. Hebrew
      27. Hindi
      28. Hungarian
      29. Icelandic
      30. Indonesian
      31. Irish
      32. Italian
      33. Japanese
      34. Korean
      35. Latvian
      36. Lithuanian
      37. Macedonian
      38. Malay
      39. Maltese
      40. Norwegian
      41. Persian
      42. Polish
      43. Portuguese
      44. Romanian
      45. Russian
      46. Serbian
      47. Slovak
      48. Slovenian
      49. Spanish
      50. Swahili
      51. Swedish
      52. Tamil
      53. Telugu
      54. Thai
      55. Turkish
      56. Ukrainian
      57. Urdu
      58. Vietnamese
      59. Welsh
      60. Yiddish
      61. Yoruba
      62. Zulu
      EN
      ES EN

      Etiam magna arcu, ullamcorper ut pulvinar et, ornare sit amet ligula. Aliquam vitae bibendum lorem. Cras id dui lectus.

      ADDRESS

      63739 street lorem ipsum City, Country

      PHONE

      +12 (0) 345 678 9

      EMAIL

      info@company.com

      Cart