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Hannah Richards at The Gut Clinic
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13
Questions
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1
Name
First Name
Last Name
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2
Email
example@example.com
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3
Do you already have a pre existing / diagnosed digestive condition?
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This field is required.
YES
NO
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4
Do you experience any of the following symptoms?
Bloating, Constipation, diarrhoea, loose bowels, mucus in stool, blood in stool and/or wind/gas.
YES
NO
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5
Would you like to reduce / eliminate your symptoms?
YES
NO
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6
Do you want to help your gut stay in optimal health for preventative health?
YES
NO
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7
Do you want to help your gut stay in remission to prevent relapse?
YES
NO
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8
Do you take anything?
Supplements to help.
YES
NO
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9
Do you feel it is really making a difference?
YES
NO
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10
Are you interested in supporting your gut health?
YES
NO
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11
Are you interested in preventative health?
YES
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12
Do you want to do more?
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13
Would you like to arrange a call with Hannah to discuss how you can reach optimal gut health?
YES
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14
Tags
Todo
In Progress
Done
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