Chronic Inflammation & Gut Health Assessment
  • Discover the hidden root causes quietly limiting your energy, performance, and longevity.

  • Chronic Inflammation & Gut Health Assessment

    Self-Care Blueprint™ with Cynthia Blancaflor, Certified Naturopath

  • Whether you exercise, meditate or are just learning how to better care for your health. Your gut can be unpredictable, your energy isn't where you want it, and inflammation keeps showing up in ways that frustrate you. This assessment helps identify exactly where the hidden gaps are so you can finally address the root cause, not just the symptoms.

  • Rate each statement: 0 = Never 1 = Occasionally 2 = Often 3 = Almost Always

  • PERSONAL INFORMATION

    Your information will be kept confidential and will only be used to stay in contact
  • Format: (000) 000-0000.

  • SECTION 1 — GUT HEALTH & DIGESTION

  • Q1. GUT HEALTH: After meals, I experience bloating, gas, or abdominal discomfort.*
  • Q2. GUT HEALTH: My bowel movements are irregular (constipation, loose stools, or alternating).*
  • Q3. GUT HEALTH: I experience heartburn, acid reflux, or indigestion.*
  • Q4. GUT HEALTH: I feel best when I avoid certain foods but haven't identified which ones.*
  • Cynthia Blancaflor Food as Medicine becomeyourownhealer.in foodasmedicine.pro
    This assessment is for educational purposes and does not constitute medical advice.

  • Q5. GUT HEALTH

  • I have taken antibiotics, prescription or over-the-counter drugs in the past 3 years.*

  • SECTION 2 — INFLAMMATION SIGNALS

  • I experience joint pain, stiffness, or body aches without a clear injury cause.*
  • I have skin issues (eczema, rosacea, acne, or persistent redness).*
  • I get sick (colds, infections) more than twice a year.*
  • I notice that certain foods (sugar, alcohol, gluten, dairy) make me feel worse.*
  • I have been diagnosed with an inflammatory condition (IBS, autoimmune, thyroid, etc.).*

  • SECTION 3 — ENERGY & COGNITIVE PERFORMANCE

  • © Cynthia Blancaflor · Food as Medicine · becomeyourownhealer.in · foodasmedicine.pro
    This assessment is for educational purposes and does not constitute medical advice.

  • Q11. ENERGY & COGNITION

  • I experience afternoon energy crashes or rely on caffeine to sustain focus.*

  • Q12. ENERGY & COGNITION

  • I have brain fog, difficulty concentrating, or memory lapses.*

  • Q13. ENERGY & COGNITION

  • Despite sleeping 7-8 hours, I wake up feeling unrested.*

  • Q14. ENERGY & COGNITION

  • My mood or motivation fluctuates significantly throughout the day.*

  • SECTION 4 — FOOD AS MEDICINE GAPS

  • Q15. FOOD AS MEDICINE

  • I eat processed, packaged, or restaurant food more than 3x per week.*

  • Q16 FOOD AS MEDICINE

  • I don't regularly include fermented foods, prebiotic fiber, or omega-3 rich foods.*

  • Q17. FOOD AS MEDICINE

  • I am unsure which foods specifically trigger my symptoms.*
  • Cynthia Blancaflor Food as Medicine becomeyourownhealer.in foodasmedicine.pro
    This assessment is for educational purposes and does not constitute medical advice.

  • Q18. FOOD AS MEDICINE

  • I follow a 'healthy diet' but still don't feel consistently well.*

  • SECTION 5 — LIFESTYLE & STRESS LOAD

  • Q19. LIFESTYLE

  • I feel chronically stressed even when life appears 'fine' on the outside.*

  • Q20. LIFESTYLE

  • I prioritize work, family, or obligations over my own health and recovery.*

  • Q21. LIFESTYLE

    Last Question
  • I exercise regularly but feel like something in my body still isn't healing.*

  • HOW TO INTERPRET YOUR SCORE

  • Add up your total score across all 21 questions (maximum 63 points).

  • HOW TO INTERPRET YOUR SCORE

    Score Range What It Means Recommended Next Step
    0 - 14 Low inflammation burden. Strong foundation in place. Optimize with targeted food-as-medicine education. Join a group or Book a 1:1
    15-28 Moderate signals. Gut and inflammation are impacting your quality of life.

    A personalized root cause protocol will create significant shifts. Join a group or Book 1:1
     29-42  High burden. Chronic inflammation and gut dysfunction are actively limiting you. A comprehensive 6-12 month regenerative protocol is strongly indicated. Book a Strategy Session
     43-63 Severe, systemic burden. Multiple systems are affected. Immediate, deep-root intervention recommended.  Book a Strategy Session 

  • SECTION SCORE TRACKER

    Record your score per section to identify your priority areas.
  • Rows

  • WHAT YOUR SCORE MEANS FOR YOUR NEXT STEP

  • Root Cause Discovery We identify the specific inflammatory triggers and gut dysfunction patterns unique to your biology - not generic protocols.
  • Food as Medicine Personalization Your food plan is built around your results - anti-inflammatory, gut-restoring, and actually sustainable for a high performer's life.
  • Regenerative Protocol A 6-12 month guided journey to reverse chronic inflammation, restore gut integrity, and optimize your longevity from the inside out.

  • Cynthia Blancaflor - Food as Medicine - becomeyourownhealer.in - foodasmedicine.pro This assessment is for educational purposes and does not constitute medical advice.

    You may print this document to score yourself and document your wellness score.

  • Ready to Address the Root Cause?

  • Book your 1:1 Wellness Strategy Session. In 60 minutes, we'll review your assessment results, identify your highest-priority healing targets, and map out a personalized regenerative protocol designed for your biology and lifestyle.

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  • © Cynthia Blancafior · Food as Medicine · becomeyourownhealer.in · foodasmedicine.pro This assessment is for educational purposes and does not constitute medical advice.
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  • Book Your Private 1:1 Wellness Strategy Call
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