One Question. One Email. Tailored Gut Support

Introduction

Thanks for reaching out to Simply Gut Health! This form is designed to offer one-off guidance on a single gut health concern. Please complete all sections thoroughly and honestly, it is better to include too much information than too little and we can only use the information that you provide us. While we’ll do our best to offer helpful, evidence-based insights, this form is not a substitute for medical advice.
Terms and Conditions*
Your details
Reference Number
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First NameLast Name
Please enter the email address that you would like us to reply to*
example@example.com
Are you filling this out for yourself, your child or someone else?*

MyselfMy child - I confirm that I have parental capacitySomeone else - I confirm I have permission to complete this form and recieve answers on their behalf
What is the age of the person with the problem?*
What kind of support are you looking for today? (Choose the option that best fits your question — we'll tailor our advice accordingly)

Help preparing for a GP appointmentHelp preparing for a Consultant or other Medical Specialist appointmentAdvice about one gut symptom (e.g. bloating, constipation, reflux)Not sure — I just need some guidanceOther
Your Primary Gut Concern
In a few sentences, please describe the main issue you’d like help with (e.g. constipation, reflux, bloating)*
How long have you/they been experiencing this?*
How often does it occur?*
What have you/they already tried?*
Have you/they seen a GP or specialist about this? If yes, what was said or diagnosed?*
Do you/they have any future appointments booked, if so, when?
Have you/they had any tests or investigations about your problem or about your digestive system (including stomach, bowel, bladder)*
Do you/they take any medications or supplements?*
Do you/they have any allergies, intolerances or medical conditions we should know about?*
Diet & Lifestyle Snapshot
How would you describe your/their current diet?*

BalancedHighly selective / fussy eaterLots of processed foodsDairy-freeGluten-freeVegetarianVeganOther (Please specify)
Water intake per day (rough estimate):*
What is your/their preferred drink?*
How would you describe your/their activity levels?*
How would you describe your / your childs overall health and do you/they have any disabilities?*
Any recent stress, travel or illness that could be a factor?*
Is there anything else that you think we should know?*
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Quick Gut Health Consult

£15.00

Bundle Flare Guide BundleYou now have the option to bundle your email consultation with our Flare-Up Guide for your condition — a practical, expert-written toolkit filled with calming strategies, tracking prompts, and daily tools to help you feel more in control. It’s a great companion to the tailored advice you’ll receive from us.

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Introduction

Your details

Your Primary Gut Concern

Diet & Lifestyle Snapshot

That's the end of the questions, thank you