QUESTIONNAIRE

Do you have any following symptoms? If so please click the appropriate responses below.

Do you get heart burn ?

Never
Occassionally
Sometimes
Often
Always

Does your stomach get bloated ?

Never
Occassionally
Sometimes
Often
Always

Does your stomach feels heavy after meals ?

Never
Occassionally
Sometimes
Often
Always

Do you subconsiously rub your chest with your hand ?

Never
Occassionally
Sometimes
Often
Always

Do you feel sick after meal ?

Never
Occassionally
Sometimes
Often
Always

Do you get heart burn after meals ?

Never
Occassionally
Sometimes
Often
Always

Do you have an unusual (eg. Burning) sensation in your throat ?

Never
Occassionally
Sometimes
Often
Always

Do you feel full while eating meals ?

Never
Occassionally
Sometimes
Often
Always

Do something gets stuck when you swallow ?

Never
Occassionally
Sometimes
Often
Always

Do you get bitter liquid (acid) coming up into your throat ?

Never
Occassionally
Sometimes
Often
Always

Do you burp a lot ?

Never
Occassionally
Sometimes
Often
Always

Do you get heartburn when you bend over ?

Never
Occassionally
Sometimes
Often
Always

ACIDITY LEVEL REPORT

TEST NAME OBSERVED VALUE NORMAL RANGE
Acidity 12-24
Analysis :
x

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