RootMap Snapshot Intake — Your Personalized Health Roadmap

Your first name *

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Email address *

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Rate each symptom by severity — how much it affects your daily life on a scale of 1 to 10.

When did your current symptoms begin or significantly worsen? *

Please select when symptoms began

What was going on in your life around that time?

Have you taken a course of antibiotics (2+ weeks) more than once in your life?

Once or twice

Multiple times

Not sure

Do you experience digestive symptoms? (bloating, gas, constipation, diarrhea, heartburn)

Rarely / never

Occasionally

Often — several times a week

Daily / most days

Do you have known food sensitivities or allergies?

How would you describe your typical bowel pattern?

How would you describe your current diet pattern?

What describes your exercise habits?

Mostly sedentary

Light — walking, yoga, occasional

Moderate — 2–3x/week consistently

Active — 4+ times/week

Current medications & supplements

What is your primary health goal right now? *

Please share what you're hoping to achieve

What does success look like to you?

Anything else Liza should know about you?

RootMap Snapshot — Your Personalized Health Roadmap

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