Maldigestion

1. Do you feel extreme fullness after having a meal?

Yes No

2. Do you suffer from heartburn?

Yes No

3. Do you experience fullness after eating even a small amount of food?

Yes No

4. Do you experience bloating?

Yes No

5. Have you noticed a recent weight gain?

Yes No

6. Do you smoke?

Yes No If yes, how many a day

7. Do you consume alcohol?

Yes No If yes, how many units per week