Celiac Symptoms Survey

35 Responses | Created by DJHildebrand | Send a Send a Gift DJHildebrand to DJHildebrand | Skip to Results

Please take a moment to help Celiac Express assess critical information for spreading knowledge about Celiac Disease with the intent of encouraging early testing. Thank you!

25 Questions, 2 minutes est. comp. time

  1. 1

    Before arriving at Celiac Express, did you know about Celiac Disease?

  2. 2

    Do you know someone with Celiac Disease?

  3. 3

    Unexplained Diarrhea, constipation, vomiting or nausea (Questions 3-20: In your opinion, do the following symptoms indicate Celiac Disease?)

  4. 4

    Unexplained allergies or asthma

  5. 5

    Unexplained abdominal pain, gas or bloating

  6. 6

    Unexplained migraine headaches

  7. 7

    Unexplained fatigue, weakness, anemia or other nutrient deficiencies

  8. 8

    Unexplained mood swings, depression, anxiety or stress

  9. 9

    Infertility

  10. 10

    Miscarriages

  11. 11

    Geographic tongue or dental enamel defects

  12. 12

    Osteoporosis

  13. 13

    Bone pain

  14. 14

    Autoimmune conditions

  15. 15

    Blood clotting disorders

  16. 16

    Failure to thrive in infants

  17. 17

    Delayed puberty

  18. 18

    Autism

  19. 19

    Appetite Changes

  20. 20

    Dementia

  21. 21

    Do you agree with the following statement: If a person test negative for Celiac Disease, they cannot later develop Celiac Disease?

  22. 22

    If you suspected that you might have Celiac Disease, how willing would you be to get tested? (1=Not at all willing; 7=definitely willing)

  23. 23

    If you learned you had Celiac Disease and that treating this condition required making dietary changes, how willing would you be to make those changes? (1=Not at all willing; 7=definitely willing)

  24. 24

    Do you know how and where you can get tested for Celiac Disease?

  25. 25

    Before arriving at Celiac Express, did you know that you must maintain your current diet to have an accurate test for Celiac Disease?

  26. 26

    Education:

  27. 27

    Age:

  28. 28

    Ethnicity/Race:

  29. 29

    Gender:

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