Gluten Test - Patient Questions

A new technology has been developed for the monitoring of gluten consumption by analyzing both urine (pee) and stool (poop) samples. In order to make these tests available to the public directly and through your healthcare provider, a series of clinical trials must be conducted to gain Food & Drug Administration (FDA) regulatory approval. A new company is being formed to accomplish this. Your answers to this survey will be used in the fundraising efforts necessary to start the new company and execute the steps necessary to make these tests available to you both through physicians and over-the-counter.

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* 1. Which of the following best describes your interest in avoiding gluten consumption?

I have been diagnosed by my physician with celiac disease.

My child has been diagnosed by his/her physician with celiac disease.

I believe my digestive system is sensitive to gluten.

I have an allergy to wheat or gluten.

I avoid gluten because I believe my general health is improved by doing so.

I do not avoid gluten consumption.

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* 2. Do you attempt to follow a strict Gluten Free Diet (GFD)?

Yes

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* 3. How successful are you at adhering to the GFD by avoiding KNOWN sources of gluten?

Extremely successful, I'm diligent in my dietary selections to never consume gluten

Very successful, but I occasionally cheat knowingly

Successful, I try most of the time, but am aware of some consumption

Not successful, I could do much better and I know it

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* 4. In which of the following scenarios do you knowingly consume gluten? (check all that apply)

When dining out and there is no guaranteed alternative to eat gluten-free

To taste appealing dishes or desserts

To continue consuming my favorite meal or drink

At my home because we don't put extra effort into preventing gluten contamination in meals

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* 5. Do you question long-term adherence to a GFD due to chronic minor exposure from unknown sources?

Yes

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* 6. Do you occasionally question incidences of accidental ingestion of gluten due to symptom presentation? If so, how frequently does this scenario occur?

Weekly

Monthly

Quarterly (4x per year)

Once or twice a year

I do not question accidental gluten ingestion.