Anti-Aging Institute
coremicrobio|me

Microbiome Test Questionnaire

Please fill in the following information as accurately as possible. This will help assess your health and lifestyle patterns related to your gut microbiome.

Personal
Your first and last name
Email address
Phone number
8-digit test ID
12-digit activation code
When is your birthday?
What is your biological sex?
How tall are you?
How much do you weigh?
In which country were you born?
In which country do you currently reside?
Which region of the world better describes your ancestry?
Were you born by C-section?
Your sample
When did you take your sample?
What is the stool consistency of your sample?
Nutrition
Do you follow a specific diet?
When did you last take probiotics?
How often do you drink alcohol?
Lifestyle
How many people live in your household?
Do you have any pets living with you?
Do you smoke?
How many hours do you sleep on average per night?
How often do you exercise?
How would you assess your current stress level?
Have you been outside of Europe in the last 6 months?
Gut health
How often do you have bowel movements on average?
Do you have regular discomfort in the gastrointestinal tract?
Do you have any allergies?
Do you suffer from any intolerances?
Do you suffer from a chronic inflammatory bowel disease?
Have you been diagnosed with any other digestive tract disease?
How long has it been since your last colonoscopy?
General health
How would you rate your physical health?
How would you assess your psychological well-being?
Do you have skin problems?
Do you suffer from any infectious disease(s)?
Do you have any mental or neurological disorders?
Do you have any of the following diseases?
Drugs
When did you last take antibiotics?
Are you regularly taking any medication?