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®.

    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)

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