Doctors & Services

Endoscopy Centre

Irritable Bowel Syndrome (IBS) Assessment* Compulsory fields

Your Name*


Date of Birth*

Telephone No.*

Height (m)*

If 5 feet 3 inches = 1.6m

Weight (kg)*

If 140 lbs = 63kg

Please complete the below questionnaire

In the past 6 months, please select if you have any of the followings:

Do you have any other gastrointestinal diseases/symptoms?

If you answered "yes" for the above question, please write down your other gastrointestinal disease/symptoms

Have you done colonoscopy within the past five years?