Health Insight Questionnaire

Your name*

Your email address*

Overall, how have you been feeling recently?

Mostly well and functioning normally

A bit ‘off’ but managing

Persistently tired / low / struggling

Clearly unwell or declining

Other

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How would you describe your energy levels?

Consistent and adequate

Low but manageable

Fluctuating (good days / bad days)

Crashing after stress, illness, or activity

Other

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How do you usually feel on waking?

Refreshed

Tired but improves quickly

Exhausted most mornings

Wired but tired

Other

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Have you noticed changes in your thinking or focus?

No change

Mild brain fog or forgetfulness

Difficulty concentrating or remembering

Word-finding or mental slowing

Other

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Do you experience any of the following physical symptoms?

Palpitations or racing heart

Dizziness when standing

Shortness of breath or poor stamina

Cold hands/feet or temperature issues

None

Other

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How is your digestion most of the time?

Generally fine

Occasional bloating or indigestion

Regular gut discomfort or food reactions

Ongoing bowel changes

Other

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Have you noticed changes in weight or appetite?

No significant change

Weight gain without clear reason

Weight loss without trying

Appetite changes or cravings

Other

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How would you describe your stress tolerance?

Normal – I cope as I always have

Slightly reduced

Stress affects me more than it used to

Stress triggers physical symptoms or crashes

Other

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Have you experienced any of the following recently?

None

Frequent infections or slow recovery

Poor wound healing or skin issues

Ongoing aches, stiffness, or inflammation

Other

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Hormonal health – which best applies?

No noticeable hormonal changes

Sleep, mood, or energy fluctuate noticeably

Menstrual or perimenopausal changes (if applicable)

Libido, muscle, or prostate/urinary changes (if applicable)

Other

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Food-related symptoms – do you notice symptoms after eating certain foods?

No clear food-related symptoms

Digestive symptoms (bloating, pain, diarrhoea, constipation)

Skin symptoms (rashes, itching, acne, eczema)

Brain or energy symptoms (fatigue, brain fog, headaches)

Mixed or unclear reactions

Other

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Timing of symptoms after food

No clear pattern

Within minutes to 2 hours (immediate reaction)

Several hours later or next day (delayed reaction)

Symptoms build up with repeated foods

Other

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Have you ever been told you have, or suspected, an allergy or intolerance?

No

Yes – confirmed allergy

Yes – suspected intolerance

Avoid certain foods without testing

Other

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Lifestyle factors that may be relevant (select all that apply):

Alcohol affects my sleep, mood, digestion, or energy

Caffeine worsens anxiety, gut symptoms, or sleep

Exercise leaves me unusually exhausted

I’ve had significant illness, antibiotics, or major life stress

Other

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In one sentence, what is your main health concern right now?

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