Eosinophilic Esophagitis Patient Guide | Final Post-Survey Questions

We hope you found this guide helpful in understanding more about eosinophilic esophagitis (EoE) and transitioning from adolescent to adult care. Please take a few moments to complete this survey and let us know how we may better serve your needs.

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* 1. What is your gender?

Female

Male

Other

Prefer not to say

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* 2. What is your age?

17 or younger

18 to 21

22 to 24

25 to 34

35 to 44

45 to 54

55 and older

Prefer not to answer

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* 3. I am a:

Person with EoE

Parent or caregiver of someone with EoE

Health care provider

Other:

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* 4. How helpful was the information in this guide?

Very helpful

Somewhat helpful

Somewhat unhelpful

Not at all helpful

No opinion/Don’t know

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* 5. After reading this guide, I have a better understanding of EoE.

Strongly agree

Agree

Disagree

Strongly disagree

No opinion/Don't know

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* 6. After reading this guide, I plan to (check all that apply):

Talk with my current provider(s) to learn more about EoE and my personal health

Talk with my provider(s) about transitioning my care to adult provider(s)

Change provider(s)

Use the tools in this guide to make the transition to adult care easier

Schedule my first adult visit

Make sure I have health insurance and understand my coverage

Locate my local pharmacy and make sure I understand all my prescriptions

Make a plan for medical emergencies

Make lifestyle changes to help me live healthier with EoE

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* 7. Would you recommend this guide to a family member/caregiver?

Yes

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* 1. What is your gender?

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* 2. What is your age?

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* 3. I am a:

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* 4. How helpful was the information in this guide?

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* 5. After reading this guide, I have a better understanding of EoE.

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* 6. After reading this guide, I plan to (check all that apply):

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* 7. Would you recommend this guide to a family member/caregiver?

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* 8. Please share any additional feedback about this guide: