Gluten
Questionnaire

Disclaimer: Please note this questionnaire is not a complete diagnosis in and of itself, and is not intended to diagonose any type of illness.

Are your health problems gluten related?
Do you have a gluten sensitivity? Often over looked as a major contributor to poor health. Gluten is highest in wheat products, particularly bread, sauces and thickeners. A total gluten allergy is called Celiacs disease, but a large portion of us (up to 30%) may have a sensitivity to gluten producing the following symptoms.
Send us your total score from this questionnaire.

Do you have:

boxdigestive problems, upset tummy?
boxbloating and gas?
boxgastric reflux or heartburn?
boxdiarrhoea or constipation?
boxpoor weight control?
boxnot growing well?
boxeating disorders, lack of appetite?
boxexhaustion, weakness, or feel tired all the time?
boxany symptoms that seem to worsen after eating bread or other wheat based foods?
boxrunny nose and sinus problems?
boxchronic iron deficiency or anaemia?
boxosteoporosis, or growing pains?
boxdermatitis, eczema or skin rashes?
boxinfertility?
boxheadaches or migraine?
boxdepression or moodiness?
boxdifficulty thinking clearly?
boxAttention Deficit Hyperactivity Disorder (ADHD)?
boxautism?
boxhyperactivity or irritability?
boxmental health issues?

Post to:
Bettalife
6 Maine Street
Dannevirke
NEW ZEALAND

Fax to +64 6 374-8564

Email to info@bettalife4u.com