Celiac Survey Participants

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1. Do you have Celiac Disease OR gluten intolerance (self-diagnosed or clinical)?

Note: Celiac Disease is an auto-immune disorder wherein the body reacts adversely to the ingestion of wheat products, or products that contain wheat (glutens). Diagnosis of Celiac Disease is very complicated and many health professionals and researchers are still sorting out how to go about it.

Do you have Celiac Disease OR gluten intolerance (self-diagnosed or clinical)? Note: Celiac Disease is an auto-immune disorder wherein the body reacts adversely to the ingestion of wheat products, or products that contain wheat (glutens). Diagnosis of Celiac Disease is very complicated and many health professionals and researchers are still sorting out how to go about it. Yes

No

Not sure

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2. Would you be interested in participating in a paper survey that looks at diagnostic issues and family reaction?

Would you be interested in participating in a paper survey that looks at diagnostic issues and family reaction? Yes

No

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3. Do you attend Western Washington University?

(We do NOT require our participants to be students at WWU.)

Do you attend Western Washington University? (We do NOT require our participants to be students at WWU.) Yes

No

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4. Please provide an address to which we may send survey materials. Your responses for the survey will be kept anonymous and your information will not be shared.

Note: If you currently attend WWU, we will set up a time and place on campus to get you the survey materials (which you can fill out on your own time).

If you do not currently attend WWU, we will mail you the survey packet with pre-paid return envelope.

Please provide an address to which we may send survey materials. Your responses for the survey will be kept anonymous and your information will not be shared. Note: If you currently attend WWU, we will set up a time and place on campus to get you the survey materials (which you can fill out on your own time). If you do not currently attend WWU, we will mail you the survey packet with pre-paid return envelope. Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:

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5. Do you know anyone with Celiac Disease who may be interested in taking the survey? (Note: we are looking for one participant per family due to the nature of the questionnaire).

Our survey relies on word of mouth to find participants- your help is very much appreciated.

Do you know anyone with Celiac Disease who may be interested in taking the survey? (Note: we are looking for one participant per family due to the nature of the questionnaire). Our survey relies on word of mouth to find participants- your help is very much appreciated. Yes

No

Maybe

6. If you know someone that may be interested in participating, please either (1) forward our information to them (this Survey Monkey) or (2) enter in their name, email address, and relation to you below so that we may contact them directly (with permission).

If you know someone that may be interested in participating, please either (1) forward our information to them (this Survey Monkey) or (2) enter in their name, email address, and relation to you below so that we may contact them directly (with permission).

7. How did you find out about this survey?

How did you find out about this survey?

Celiac Survey ParticipantsExit this survey

*2. Would you be interested in participating in a paper survey that looks at diagnostic issues and family reaction?

*3. Do you attend Western Washington University?(We do NOT require our participants to be students at WWU.)

*5. Do you know anyone with Celiac Disease who may be interested in taking the survey? (Note: we are looking for one participant per family due to the nature of the questionnaire). Our survey relies on word of mouth to find participants- your help is very much appreciated.

6. If you know someone that may be interested in participating, please either (1) forward our information to them (this Survey Monkey) or (2) enter in their name, email address, and relation to you below so that we may contact them directly (with permission).

7. How did you find out about this survey?

Celiac Survey Participants
Exit this survey

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2. Would you be interested in participating in a paper survey that looks at diagnostic issues and family reaction?

*
3. Do you attend Western Washington University?

(We do NOT require our participants to be students at WWU.)

*
5. Do you know anyone with Celiac Disease who may be interested in taking the survey? (Note: we are looking for one participant per family due to the nature of the questionnaire).

Our survey relies on word of mouth to find participants- your help is very much appreciated.