Please select your gender.

 Male Female                                                                  

What is your age range?

 18-30

 30-40

 40-50

 50+

How often do you move your bowels?

 Once a day

 Twice or more a day

 Once every other day

 A few times a week or less

How much time does it usually take you to poop?

 Less than a minute

 1 - 2 minutes

 2 - 5 minutes

 More than 5 minutes

What is the usual ‘shape’ of your poop?

 Separate hard lumps, like nuts

 Sausage shaped, but lumpy

 Like a sausage or snake, smooth and soft

 Soft blobs with clear-cut edges

 Fluffy and mushy little pieces

 Watery, no solid pieces

How many processed foods do you eat a day?  (anything from a box or package)

 1 or less

 2-4 servings

 5-9 servings

 9 or more servings

How long do you usually take to eat a meal?

 I take my time, usually 30 to 60 minutes or more

 15 to 30 minutes is about average

 I’m usually on the go so seldom more than 10 minutes

How much water do you drink per day?

 At least 8 glasses

 5-7 glasses

 2-4 glasses

 1 or less

How often do you suffer from constipation?  (pooping less then 2-3 times per week)

 Nearly every week

 Once or twice a month

 Few times a year

 None that I can remember

My stress levels on any given day is:

 Low

 Moderate

 High