IBD Study - Enrollment Interest Questionnaire
Thank you for your interest in the Texas A&M University Gastrointestinal Laboratory IBD Study. This questionnaire is designed to gather some initial information about the patient. Please answer the following questions.
Your first name (veterinarian) *
Your answer
Your last name (veterinarian) *
Your answer
Preferred email address for correspondence *
Please ensure this is correct so we can contact you!
Your answer
Your phone number *
Please include area code
Your answer
Patient's name *
Your answer
Patient's breed *
Your answer
Patient's age (years) *
Your answer
Owner's last name *
Your answer
Is the dog currently exhibiting clinical signs of chronic gastrointestinal disease? *
Has the dog had chronic signs of gastrointestinal disease lasting at least three weeks? *
Do you already have gastrointestinal biopsies? *
Do you plan to obtain gastrointestinal biopsies? *
Please consider whether the owner is willing as well as the health status of the patient. Our Animal Use Protocol prohibits us from requesting you perform biopsies or compensating for obtaining them, so you must be planning to obtain biopsies as part of your diagnostic process.
If you need to elaborate on the issue of biopsies, please do so below.
Please note: we cannot enroll patients that will not have histology performed on gastrointestinal biopsies because it is very important for our research to categorize samples on the basis of histopathology.
Your answer
Has the dog received any immunomodulatory drug in the past six months? *
Please note this includes NSAIDs and medications used for any purpose, whether related to gastrointestinal signs or not.
If you answered "yes" or "other" regarding immunomodulatory drugs, please elaborate.
Please at a minimum include the medication, dosage, purpose, and date of last dose.
Your answer
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