Celiac/Coeliac Wheat/Gluten-Free Survey

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We here at Trinity College Dublin would be most grateful if you could complete this very brief survey regarding your dining out eating experiences - it should take less than 2 minutes to complete.

Your participation in the survey is completely voluntary and all of your responses will be kept confidential. The results of the survey will be reported in a summary format, so no one will link you to your responses.

Thank you in advance for your participation in this important project. If you have any questions about the administration of the survey, please email Conor at coeliacsurvey@gmail.com.

Sincerely,

Conor

1. Age Bracket *

0 to 15

16 to 25

26 to 35

36 to 50

51 to 65

66+

Other:

2. Gender? *

Female

Male

3. In what country do you reside?

4. Are you a diagnosed celiac? *

Yes (please continue to question 6)

5. Do you have a gluten intolerance or wheat allergy?

Yes

Clear selection

6. How often do you eat out? *

Never

Rarely (less than once a month)

Sometimes (1-3 times per month)

Often (4-8 times per month)

Very Often (twice a week or more)

7. How easy or difficult do you find it to eat out gluten free? *

Very Easy

Easy

Neutral

Difficult

Very Difficult

8. How important is it that restaurants identify gluten free options on their menu? *

Not Important

Somewhat Important

Important

Very Important

Extremely Important

9. Have you ever experienced a negative reaction to gluten from eating out, even when food was marked as gluten free? *

Yes

No (please skip to question 12)

10. Please describe the most recent experience of a negative reaction, how do you feel this could have been prevented?

11. How often would you experience a negative reaction to gluten from eating out?

Rarely

Sometimes

Often

Very Often

Clear selection

12. Would having a negative reaction impact on your decision to return to a restaurant? *

Yes, possibly

Yes, most definitely

13. In general, please rate how knowledgable staff in restaurants are about gluten free requirements? *

Very Poor

Poor

Average

Good

Excellent

14. Would you be more likely to go to a restaurant where staff are more knowledgeable about gluten free requirements? *

No more likely or unlikely

A little more likely

More likely

Much more likely

15. Would you be more likely to go to a restaurant which had been independently or externally inspected to ensure adequate facilities and knowledge for gluten free offerings? *

No more likely or unlikely

A little more likely

More likely

Much more likely

16. How interested would you be in having a list of independently and externally vetted food establishments where you can be assured of a gluten free experience? *

Not at all interested

Extremely Interested

17. Would you like to be involved in focus group sessions in relation to this topic?

Yes

Clear selection

18. If you answered Yes, please submit a valid email address so that we may contact you.

Submit

Clear form

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