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Table 1 Questionnaire Summary

From: The Canadian celiac health survey – the Ottawa chapter pilot

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