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Hiatal Hernia
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1) Do you have regular acid reflux symptoms?
*
Yes
No
2) Have you become dependent on acid blocking drugs such as the proton pump inhibitors life Prilosec, Aciphex, Nexium, Protonix, etc?
*
Yes
No
3) Do you have an unexplained cough, hoarseness, or wheezing?
*
Yes
No
4) Do you have Barrett's esophagus?
*
Yes
No
Don't know
5) Do you use nutritional supplements for your hiatal hernia?
*
Yes
No
6) Have you had an upper GI endoscopy?
*
Yes
No
7) Do you have difficulty swallowing?
*
Yes
No
8) Have you measured your B12 level?
*
Yes
No
9) Do you eat within 3 hours of bedtime?
*
Yes
No
10) Are you interested in lifestyle, dietary, and supplement recommendations to help your symptoms?
*
Yes
No
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