Gastrointestinal (GI) Nutrition Programme Gastrointestinal (GI) Nutrition Programme Name Name First Name First Name Last Name Last Name Email Phone Date of Birth Gender Option 1 Do you have a diagnosed GI condition? Yes No If yes, what is your diagnosis? GI Condition Type Irritable Bowel Syndrome (IBS) Crohn’s Disease Ulcerative Colitis GERD (Acid Reflux) Small Intestinal Bacterial Overgrowth (SIBO) Celiac Disease Other Are you currently on medication for GI health? Yes No List any medications or supplements you take for digestion. Do you experience food intolerances? Lactose Intolerance Gluten Sensitivity High FODMAP Foods Spicy Foods Other Current Diet Type Low-FODMAP Diet High-Fiber Diet Gluten-Free Diet Mediterranean Diet Standard Diet Other Other Are you following any dietary restrictions? Dairy-Free Low-Sugar Low-Fiber No Restrictions Other How often do you experience digestive discomfort? RarelyA few times a monthA few times a weekDaily How much water do you consume daily? Biggest Digestive Challenges Bloating Constipation Diarrhea Acid Reflux/Heartburn Gas/Indigestion Food Sensitivities Other Other Meal Plan Preferences Low-FODMAP Meal Plan Anti-Inflammatory Diet Gut Healing & Probiotic-Focused Plan High-Fiber & Digestion Support Plan No Specific Preference Would you like guidance on probiotics & gut health? Yes No Would you like a personalized supplement recommendation? Yes No Do you require help with meal preparation? Yes No Would you like stress management strategies for GI health? Yes No Improve My Gut Health Package Selection Basic Meal PlanPersonalized Plan with Dietitian ConsultationPremium Support with Weekly Adjustments Payment Terms and Condition * I confirm that the information provided is accurate, and I agree to the terms of the GI Nutrition Programme. If you are human, leave this field blank.
