Functional Wellness
Functional Health Survey
A detailed look at your symptoms, digestion, energy and daily habits — completed before your visit so your appointment starts with real information.
Or call (936) 262-1108
Why we ask
The survey walks through symptoms and lifestyle patterns that standard intake forms miss: digestion and stomach acid, gut overgrowth signs, energy and sleep, stress, nutrition, and the habits that shape how you feel day to day.
Your answers give your provider a head start, so your first appointment can be spent discussing what matters instead of gathering basics. It takes most people about 15–20 minutes, and your responses are kept confidential.
Inside the survey
What it covers
Patient information
Basic details plus the symptoms or conditions that concern you most and when they began.
Lifestyle habits
Food and drink patterns, exercise, special diets, and any food sensitivities or reactions.
Digestive screening
Questions covering low and high stomach acid, bacterial overgrowth and candida symptoms.
Whole-body symptoms
Energy, sleep, mood, hormones and other patterns that point toward underlying imbalances.
Before you start
- Set aside about 15–20 minutes somewhere quiet
- Have a list of current medications and supplements handy
- Note when your main symptoms started
After you submit
- Your provider reviews your answers before your visit
- Lab testing may be recommended based on your responses
- You'll leave your appointment with a personalized plan