Interview Screener
Thank you for your interest in speaking with us about your experience with Celiac Disease. Whether you have Celiac Disease or are providing for someone who does, your insight into life with this illness is valuable. We are particularly interested in understanding the patient journey of adolescents with Celiac Disease. The information provided herein will remain confidential.
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Are you a patient with Celiac Disease or a caregiver for someone with Celiac Disease? *
How old are you/is the patient with Celiac Disease? *
How old were you when you were diagnosed with Celiac Disease?
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When were you/the patient diagnosed with Celiac Disease? *
Which of the following diagnostic tests were used to confirm your/the patient's Celiac Disease diagnosis? (Check all that apply) *
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Are you/the patient currently eating a gluten free diet?
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Are you/the patient currently seeing a medical professional for treatment and management of Celiac Disease?
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Contact Information
Thank you for your time! We look forward to getting in touch with you!
First Name *
Email (to contact you) *
If you would like us to contact you by a method other than email (e.g. phone number) please provide it below
How would you like to be interviewed? *
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