JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Survey on celiac disease
This survey explores medical experiences, social attitudes and awareness related to Celiac Disease in South Asia. Celiac is a disease where eating gluten damages the body's immune system and lining of small intestine.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Age
*
Below 18
18-25 years
25-45 years
45-65 years
Other:
Where do you live?
*
Your answer
Gender
*
Male
Female
Other
Have you heard of celiac disease? (gluten intolerance/ allergic to wheat)
*
Yes
No
If yes, how do you know about it?
*
A friend/ family member has it
I have it
Social Media
Other:
Were the symptoms recognised by doctors promptly?
*
yes
no
Other:
Have you or someone you know faced pressure to eat gluten? If yes explain briefly. Write no otherwise.
*
Your answer
Do you think normalising digestive issues delays the diagnosis of celiac?
*
Yes
No
Other:
If you were diagnosed with it, would you take it seriously?
*
Yes
No
Other:
How do you think your life would change after the diagnosis? Explain briefly.
*
Your answer
Any additional comments on awareness, social attitudes or medical care?
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report