Ulcerative Colitis Questionnaire 940 E. El Camino Real Sunnyvale, CA 94087 harminder@homeopathicvibes.com www.homeopathicvibes.com Office Phone (408)737-7100 Office Fax (408)737-7102 Name *FirstLastEmail *Phone *Do you have abdominal pain on your lower left side? Yes NoDo you have bloating before a bowel movement or passing gas? Yes NoDo you have abdominal tenderness? Yes NoDo you have blood in your stools? Yes NoHave you been experiencing nausea and/or vomiting? Yes NoHave you been experiencing constipation? Yes NoHave you been experiencing diarrhea? Yes NoHave you been experiencing both constipation and diarrhea? Yes NoDo you feel as if you have to have another bowel movement soon after having one? Yes NoDo you have mucus or pus in your stools? Yes NoIs your pain alleviated after a bowel movement? Yes NoIs your pain on the lower right side of the abdomen just below the bellybutton?Yes NoDo you have any surgeries recently? Yes NoHow many flare ups you have had recently in last 12 months? Yes NoHow many times you were on steroids in last 12 months? Yes NoHave you consulted some Homeopathic or alternative consultant recently? Yes NoExplain how long and where?PhoneSubmit