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. 2003 May 11;3:8. doi: 10.1186/1471-230X-3-8

Table 1.

Questionnaire Summary

Demographics
 Age, sex, age of diagnosis
 Level of education, family income
Diagnosis
 Pre-diagnosis symptoms and duration
 Status of recovery from symptoms
 Other diagnoses
 Possible triggers
 Number and types of doctors consulted
Diet
 Adherence to gluten-free diet
 Difficulty in following diet
 Rating of information sources
 Difficulty with labelling of foods
Quality of Life
 SF12 Health Survey ©
 Celiac-specific quality of life questions for adults/children
Bone disease
 History of fractures
 Bone density status
 Osteoporosis treatment
Reproduction
 Specific questions for women and men
Celiac disease in family members
 Testing of first-degree relatives for CD
 Suspected CD in family
Other diseases of members/ first-degree relatives
 Gastrointestinal, cancer, autoimmune, blood, endocrine, neurological, musculoskeletal, other