Yes or No?

Are you ever bloated, gassy, get heartburn, or full--even after small meals? *

Rarely, no

Occasionally/Mild (2-3x/month)

Most Days (3-5x/week)

Yes, every day

Yes or No?

Do you have irregular bowel movements? (Constipation, hard or infrequent stools, loose stools or diarrhea, or alternating?) *

No, I'm regular

Occasionally irregular

Often irregular

Yes, constantly struggling

Describe.

What do you feel after eating? *

Fine

A little tired

Foggy, cloudy, lethargic

Anxious, bloated, or reactive

Yes or No?

Do you catch colds frequently or feel like your immune system is worn out? *

No, I recover quickly (<1x/year and better within 2-3 days)

Occasionally (1-2x/yr and it can take longer to feel better)

I get sick often (If it's going around, I catch it)

Yes, I never feel fully recovered

Pick All that Apply

Have you ever been told you have: *

Autoimmune or immune dysfunction

Food sensitivities

Histamine Intolerance or MCAS

Mold illness, EBV, Lyme

None of the above

Yes or No?

Do you react to foods, supplements, or smells in a way that feels abnormal or hard to control? *

Occasionally/Mild (e.g. yes to some foods and no to supplements or smells)

Frequently/Often (Yes to one or more on a regular basis)

Yes, it's a daily problem

Yes or No?

Do you experience brain fog, difficulty concentrating, or forgetfulness? *

Rarely, every once in a while

I'm noticing it more often

Weekly (Something is definitely off)

Daily (It's limiting my abilities or affecting my work)

Pick One.

How would you describe your energy levels? *

Steady and good

Off and on fatigue, even with sleep

Drained by afternoon/slump

Lethargic, unmotivated, exhausted

Yes or No?

Do you feel anxious, trouble sleeping, or overwhelmed often for no apparent reason? *

Mild

Often

It's constant.

Yes or No?

Have your symptoms become worse following lengthy illness, accident, stressful event, or other? *

Unsure

Possibly

Yes, absolutely

Where Can I Send Your Results?

First Name *

Email *

Cell Phone *

I agree to terms & conditions provided by Pucci Wellness. By providing my phone number to Dr. Pucci's office, I agree to receive text messages from Pucci Wellness about my inquiry and results. (We will never spam you, and you are always welcome to opt out.)

🔒 Your information is secure. We never share or sell your contact details.