A few questions from Dad

Hi. I want to understand what is going on with your stomach so I can help you get better.

There are 11 questions and it takes about 4 minutes. Tap an answer, or skip any you would rather not answer. There are no wrong answers and nobody is in trouble.

Nothing is sent until you tap send at the end.

When you try to eat, what happens first?

This helps the doctor tell a stomach problem from a swallowing problem.

Tap all that apply.

Trouble swallowing Nausea or gagging Full after a few bites Belly pain Dread that it will make me sick Nothing in particular

Where do you feel pain or discomfort?

This is one of the most useful things the doctor can see. Tap the spots. Use the buttons to switch between the front and the back.

Somewhere else on my body I do not have pain

How soon after you start eating does it begin?

When it starts helps point to where the problem is.

Before the first bite After a few bites 20 to 60 minutes later It varies Not sure

Do liquids like smoothies go down easier than solid food?

If liquids are easier, there are ways to get you more calories without forcing solid food.

Liquids are easier Solid food is easier About the same Not sure

What else do you notice after eating?

Different symptoms point to different tests.

Tap all that apply.

Bloating Heartburn or sour taste Throwing up Diarrhea Constipation Greasy or floating poop None of these

Have you had any of these?

These tell the doctor how fast to act.

Tap all that apply.

Black or bloody poop Waking at night with diarrhea or pain Fever or night sweats Food feeling stuck in my chest or throat Throwing up green or yellow None of these

Do you worry that eating will make you feel sick?

Being afraid of getting sick again is common after a stomach bug, and there is help for it.

Not really Sometimes A lot

Since the March illness, has your stomach ever felt completely normal?

It shows whether this is one long illness or a few separate ones.

Never For a while, then it came back Mostly yes

Have you taken any of these since March?

Some medicines and products can upset the stomach. This is only so the doctor has the full picture.

Tap all that apply.

Ibuprofen, naproxen or aspirin Antibiotics Stomach or anti-nausea medicine Protein powder, creatine or pre-workout Energy drinks Nicotine pouches or vape Cannabis None of these Prefer not to say

How have you been feeling otherwise?

Not eating much can affect the whole body, and stress can affect the stomach.

Tap all that apply.

Very tired Always cold Dizzy when I stand up Heart racing Trouble sleeping Stressed or anxious Feeling down None of these

Anything else you want Dad to know?

You can include what the doctor has said so far, or what the plan is. Anything you remember helps.

All done. Look it over.

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