Intake Questionnaire

I don't feel very thirsty and have to remind myself to drink water

I think too much or have constant mental stimulation

My stress stems from anger and frustration

My stress is rooted in poor sleep or lack of rest

I set a consistent bedtime window (within 30 minutes every night)

I go to bed at a different time every night

I wake during the night because I am in physical pain

I wake during the night because my mind is active or I am worried

I wake during the night more than once to urinate

Something else often wakes me up during the night (spouse/partner, dog, baby, phone)

I wake during the night to have a bowel movement

I often have days with no bowel movement at all

I have one bowel movement a day (or less)

I usually have one to three bowel movements per day

I regularly have more than 3 bowel movements per day

https://storage.tally.so/aa5b5bc9-1dbe-4e29-b2a4-8bff64e21826/BristolStoolChart.png

no, I do not have to push, my bowel movements are easy

No, my bowel movements do not usually have a strong odor

Yes, my bowel movements often have a strong odor