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  1. Surveys
  2. 2011
  3. September
  4. C
  5. CD 2011
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You are invited to participante in this on-line survey to better understand coeliac disease and the role of intestine (bowell floral.

Background
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The survy is part of a larger study exploring gastrointestinal bacteria in peple with coeliac disease.


Participation
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Your participantion is completely voluntary
Your answers will remain confidential and no individual identified


Consent
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Completion and return of this surey implies your consent


Complaints
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If you have any complaints about this research project, please write to: Ethics Committee Complaints Officer, Human Research Ethics Committee, PO Box 157 Lismore NSW 2480 or email [email protected]
 
 
1. What tests have you had to confirm your diagnosis of coeliac disease?
Yes Unsure No
Blood test
Small bowel biopsy
Genetic test (to see if you carry the gene for CD)
 
 
2. Indicate the symproms you suffered at the time of diagnosis
Never Once or twice a week About once a week Almost every day Every day
Anaemia
Bloating
Fatigue
Headache
Constipation
Diarrhoea
Depression
 
 
 
3. Do you follow a strict gluten free diet?
 
Yes
 
No
 
 
4. What health professionals have you seen about your coeliac disease?
Yes Unsure No
a. Natropath
b. Gastroentrologist
c. Local doctor / GP (General practioner)
d. Dietitian or nutritionist
 
 
5. How often has your doctor perscribed you antibiotics?
Unsure Never 1 course every 5 years 1 or 2 courses each year More than 3 courses each yaer
As Child (to age 18 years)
As Adult (18 years and older)
 
 
6. What baby formula were you given to age 6 mths?
Yes Unsure No
Breast fed only
Soy based formula
Goat milk formula
Cow milk formula
Cow milk (lactose free)
Combination of formula's
 
 
 
7. What is your gender?
 
Male
 
Female
 
 
 
8. What is your age (in years)?
   
 
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