Functional Blueprint™ Symptom Assessment Quiz
A comprehensive questionnaire to assess your symptoms and guide your health journey.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Which of the following best describes your most bothersome symptoms?
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Bloating, gas, constipation, diarrhea, or abdominal pain
Fatigue, brain fog, poor sleep, or difficulty concentrating
Mood changes, anxiety, depression, or irritability
Weight gain, difficulty losing weight, or metabolic issues
A combination of several of the above
Which of the following gut symptoms do you experience regularly? (Select all that apply)
Bloating after meals
Constipation or diarrhea
Food sensitivities or reactions
Nausea or reflux
Skin issues — eczema, psoriasis, acne, or rosacea
None of the above
Which of the following energy and brain symptoms do you experience regularly? (Select all that apply)
Fatigue that does not improve with rest or sleep
Brain fog — difficulty concentrating, word-finding, or memory
Afternoon energy crashes
Unrefreshing sleep — waking up tired after a full night
Difficulty falling asleep or staying asleep
Wired but tired — exhausted but unable to relax
None of the above
Which of the following mood and mental health symptoms do you experience regularly? (Select all that apply)
Generalized anxiety or constant worry
Panic-like feelings — racing heart, chest tightness, shallow breathing
Low mood or depression that does not have an obvious cause
Irritability or mood swings — especially related to food or time of day
Lack of motivation or emotional flatness
Feeling overwhelmed by things that did not used to bother you
None of the above
Which of the following metabolic or weight-related symptoms do you experience regularly? (Select all that apply)
Weight gain that seems unrelated to diet or exercise
Inability to lose weight despite consistent effort
Sugar or carbohydrate cravings that feel uncontrollable
Feeling hungry shortly after eating a full meal
Cold hands and feet, feeling cold all the time, or low body temperature
Hair thinning or hair loss
None of the above
Have you been diagnosed with or suspected of having any digestive conditions? (Select all that apply)
IBS, Crohn's, colitis, or other digestive diagnosis
SIBO — small intestinal bacterial overgrowth
Candida or yeast overgrowth
None of the above
Have you been diagnosed with or suspected of having any hormonal or systemic conditions? (Select all that apply)
Thyroid disorder — hypothyroid, Hashimoto's, or hyperthyroid
Adrenal fatigue or HPA axis dysfunction
PCOS or hormonal imbalance
None of the above
Have you been diagnosed with or suspected of having an autoimmune condition? (Select all that apply)
Autoimmune condition of any kind
None of the above
Which of the following have you already tried in an attempt to feel better? (Select all that apply)
Multiple doctor visits with no clear answers
Prescription medications including antidepressants, thyroid medication, or proton pump inhibitors
GLP-1 medications for weight loss
Birth control or hormone replacement therapy
Elimination diets or specialized eating plans
Multiple supplements with inconsistent results
Over-the-counter gut cleanses or parasite protocols
Functional or integrative medicine consultations
Nothing yet — I am just beginning to look for answers
Does your family history include any of the following? (Select all that apply)
Digestive cancers or polyps
Type 2 diabetes or metabolic syndrome
Thyroid disorders
Cardiovascular disease at an early age
Autoimmune conditions
None of the above
Based on your symptoms above, which area concerns you most right now?
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My gut and digestive health
My energy, metabolism, and mood
Both areas equally concern me
When it comes to investing in your health, which best describes you?
I have tried many things and I am ready to invest in real answers
I am cautious about spending but this feels important enough to prioritize
I need to understand exactly what I am getting before I commit
Cost is not my primary concern — results are
Which statement best describes where you are right now?
I am exhausted from being dismissed and I am ready for real answers — whatever it takes
I have been managing my symptoms for years and I finally want to understand what is really going on
I am just starting to explore options and want to learn more before committing
I feel desperate — my quality of life is significantly affected and I need help now
I am skeptical but curious — I have tried things before that did not work
Submit
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