Mind · Body · Spirit · Family Wellness
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Family Wellness Check-In

A two-week symptom-frequency reflection adapted from the uploaded Rooted & Rising Gut Score questionnaire. The original totals (0–24 and 0–18) are retained for personal tracking, not medical severity classification. This page does not save, send, or share your answers.

Important: This questionnaire is not a diagnostic or validated clinical instrument. It cannot identify autism, dysbiosis, parasites, nutrient deficiencies, or the cause of symptoms. Seek professional evaluation for ongoing concerns. For emergencies such as vomiting blood, green vomit, severe pain, or serious dehydration, seek urgent/emergency medical care immediately rather than waiting for a program.
Step 1 · Context

Who are we checking in on?


Parents or guardians should complete this for minors. If a question does not fit your age group, this tool may not be appropriate; consult your clinician instead.

Step 2 · Safety first

Any concerns needing medical attention?

Select any signs currently present or recently observed. These are not all emergencies, but some need urgent evaluation.

Step 3 · Digestive observations

Digestive symptom frequency

During the past two weeks, how often did you notice each observation?

B1. Hard, dry, lumpy stools or stools that seemed painful to pass
B2. Straining, holding stool in, or going three or more days without a bowel movement
B3. Loose or watery stools, or sudden urgency
B4. Gas, bloating, or a belly that seemed swollen
B5. Signs of belly pain or discomfort
B6. Spitting up, reflux symptoms, or discomfort after eating
B7. Unusually strong-smelling stools
B8. Visible pieces of undigested food in stool
Step 4 · Related observations

Sleep, eating, mood, energy, and skin

These observations may have many different causes. This score does not establish a gut-brain disorder or a causal link to digestion.

C1. Difficulty falling asleep, staying asleep, or waking upset
C2. Irritability or intense changes in mood
C3. Restlessness, worry, or appearing uncomfortable
C4. Refusing foods or eating a very limited variety
C5. Low energy, tiredness, or appearing unusually disengaged
C6. Eczema, rashes, itching, or hives
Step 5 · Your family notes

Additional context



For family history, medications, supplements, diagnoses, and developmental communication notes, use the accompanying questionnaire document with your care team. Do not enter identifying medical information on this preview site.

How to use these observations

Start with patterns

Compare answers over time at baseline, week 6, and week 12. A change in frequency is an observation, not proof of a specific cause or treatment effect.

Bring concerns to a clinician

Discuss persistent bowel changes, pain, growth concerns, food restriction, sleep problems, or new symptoms with an appropriate healthcare professional.

Choose support freely

Rooted & Rising education and optional outside referrals are separate choices. Questionnaire totals do not determine what you must purchase.