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Digestive Health Screening

Please kindly complete this questionnaire as part of the Digestive Health Screening Panel.

Contact Number

About your gut

Do you experience pain in the gastric area?

Do you experience burning in the gastric area?

Do you feel full quickly after starting a meal?

After eating, do you feel uncomfortable fullness or bloating?

Do you experience uncomfortable bloating?

Do you experience discomfort or pain in your abdomen?

Do you pass motion 3 times or more a day?

Do you pass motion every day?

Do you pass motion at least 2 times a week?

Do you experience difficulty passing motion?

Do you have a feeling of incomplete bowel movements?

Have you noticed blood in your stools?

Have you noticed any black-coloured stools?

Stool Chart

Other information (Optional)

Are you a smoker?

By providing or making available my personal data in this form, I agree that Thomson Medical Group Limited and its related companies and its representatives, agents and business partners may collect, use and disclose my personal data for the purposes of providing updates on services, events, information and other reasonably related purposes in accordance with the Personal Data Protection Act 2012 and Thomson Medical Group Limited's personal data protection policy available at its website https://www.thomsonmedical.com/personal-data-protection-policy.

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Please visit Thomson Medical Group Limited's website at https://www.thomsonmedical.com/personal-data-protection-policy for further details on Thomson Medical Group Limited's personal data protection policy, including how you may access and correct your personal data or withdraw consent to the collection, use or disclosure of your personal data.