Questionnaire de santé et demande de test

Complete this intake form so our contracted practitioner can review your health history and place the appropriate lab order on your behalf. GI MAP Test acts as an intermediary between you and our independently contracted practitioners.

Cet achat peut être admissible HSA/FSA. Vous pouvez payer directement avec votre carte de débit HSA ou FSA, ou payer de votre poche et soumettre votre reçu pour remboursement. En savoir plus
1 Informations personnelles
2 Antécédents médicaux
3 Santé digestive
4 Mode de vie
5 Sélection du test

Personal Information

Basic details so we can get in touch and prepare your kit.

Antécédents médicaux

This helps our practitioner understand your full health picture.

Your health information is kept strictly confidential and is only used by our practitioner to guide your testing and protocol recommendations.

Digestive Health & Symptoms

Help us understand what you're experiencing so we can recommend the right test.

Lifestyle & Diet

These factors directly affect gut health and help us interpret your results.

Test Selection & Final Details

Almost done — choose your package and let us know anything else.

GI MAP Test acts as an intermediary service. Your lab order will be placed by an independently contracted practitioner on your behalf. Practitioner liability is held by the ordering practitioner, not by GI MAP Test.

You will be able to select and purchase your test on the next page.