Name: GI-MAP™ Stool Test Kit
Brand: GI MAP Test
Price: 525 USD
Availability: InStock

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Personal Information

Basic details so we can get in touch and prepare your kit.

First Name *

Last Name *

Email Address *

Phone Number *

Preferred Contact Method *

Date of Birth *

Biological Sex *

Gender Identity

Country *

Province / State *

City *

Medical History

This helps our practitioner understand your full health picture.

Your health information is kept strictly confidential and is only used by our practitioner to guide your testing and protocol recommendations.

Have you been diagnosed with any of the following? Check all that apply

IBS (Irritable Bowel Syndrome)

IBD (Crohn's / Colitis)

Celiac disease

SIBO

GERD / Acid reflux

H. pylori infection

Candida overgrowth

Parasitic infection

Autoimmune condition

Thyroid disorder

Diabetes / Insulin resistance

Anxiety / Depression

Eczema / Psoriasis / Skin

Hormonal imbalance

Food allergies / sensitivities

Chronic fatigue / Fibromyalgia

Other diagnoses or conditions not listed above

Current Medications *List all prescription medications, including dosage if known

Current Supplements & Natural Health ProductsVitamins, herbs, probiotics, etc.

Have you taken antibiotics in the past 12 months? *

Acid-reducing medication?PPIs, H2 blockers, antacids

Taking immunosuppressant drugs?

Known Allergies *Drug allergies, food allergies, environmental allergies

Previous SurgeriesEspecially abdominal/GI surgeries

Recent HospitalizationsPast 2 years

Family Medical HistoryGI conditions, autoimmune disease, cancer, or other relevant conditions in immediate family

Are you currently pregnant or breastfeeding?

Digestive Health & Symptoms

Help us understand what you're experiencing so we can recommend the right test.

What are your primary health concerns? *What's motivating you to get tested?

How long have you been experiencing these symptoms? *

Current Digestive Symptoms Check all that you experience regularly

Bloating / distension

Excessive gas

Constipation

Diarrhea / loose stools

Alternating constipation & diarrhea

Abdominal pain / cramping

Heartburn / acid reflux

Nausea

Urgency / can't hold it

Incomplete evacuation

Mucus in stool

Blood in stool

Undigested food in stool

Floating / oily stools

Food reactions / intolerances

Loss of appetite / early satiety

Other Symptoms You Experience Check all that apply

Fatigue / low energy

Brain fog / poor concentration

Joint pain / stiffness

Skin issues (acne, eczema, rashes)

Headaches / migraines

Sleep problems / insomnia

Mood changes / irritability

Unexplained weight changes

Hair loss / thinning

Frequent illness / poor immunity

Sinus congestion / post-nasal drip

Hormonal symptoms (PMS, irregular)

How would you rate the overall impact on your daily life? *

1Minimal

3Moderate

5Severe

Average bowel movements per day *

Typical stool consistency (Bristol Stool Scale) *

Known food triggers or sensitivities

Lifestyle & Diet

These factors directly affect gut health and help us interpret your results.

How would you describe your current diet? *

Describe your typical daily dietA rough idea of what you eat on a normal day

Daily water intake

Caffeine consumption

Alcohol consumption

Tobacco / Cannabis use

Exercise frequency

Average sleep per night

How would you rate your current stress level? *

1Very low

3Moderate

5Very high

Have you done any previous gut or functional testing?e.g. previous GI-MAP™, stool culture, SIBO breath test, food sensitivity test

Test Selection & Final Details

Almost done — choose your package and let us know anything else.

⚠ Lab Ordering Not Available in Your State

We're sorry — we are currently unable to support lab ordering for patients in New York, New Jersey, and Rhode Island. If you believe this is an error, please contact us.

👤 Parental / Guardian Consent Required

Because the patient is under 18 years of age, a parent or legal guardian must provide consent for this lab order to be placed by our contracted practitioners.

Parent / Guardian Full Name *

Parent / Guardian Email *

Parent / Guardian Phone *

Relationship to Patient *

I, the parent/legal guardian, consent to this lab order being placed on behalf of the minor named above. I understand that a contracted practitioner will order and facilitate the lab work through GI MAP Test as an intermediary service. *

Which test package interests you? *

GI-MAP™ Standard$525

GI-MAP™ + Zonulin Most Popular$600

H. Pylori Profile$237

Not sure yet — help me chooseFree consult

Are you currently working with a healthcare practitioner?

What are you hoping to learn or achieve from this test? *

Anything else you'd like us to know?

How did you hear about us?

GI MAP Test acts as an intermediary service. Your lab order will be placed by an independently contracted practitioner on your behalf. Practitioner liability is held by the ordering practitioner, not by GI MAP Test.

I verbally consent to the GI MAP Test team ordering and handling lab work on my behalf. *

I understand this form is for a health intake assessment and does not constitute a medical diagnosis. I consent to having my information reviewed by a contracted practitioner for the purpose of GI-MAP™ test ordering and protocol guidance. *

I consent to allow the lab to communicate with me via email regarding my health information. *

I have read and agree to the Refund Policy. I understand that all sales are final, no refunds are issued after shipment, and a 10% restocking fee applies to any approved pre-shipment cancellation. *

I have read and agree to the Privacy Policy and Terms of Service. *

You will be able to select and purchase your test on the next page.

Health Intake & Test Application

Personal Information

Medical History

Digestive Health & Symptoms

Lifestyle & Diet

Test Selection & Final Details