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GliadinX Community Survey

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GliadinX Community Survey

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Guided by our mission to help families more confidently and safely navigate unintended gluten exposure, we are grateful for your participation. Your confidential responses will help us better understand our community, and will allow us to share meaningful insights.

This survey takes less than 3 minutes.

*

1.

Who do you buy GliadinX for? Please check all that apply.[Checkboxes]

I buy GliadinX for my personal use.

I buy GliadinX for my child.

I buy GliadinX for other family members.

Other: (please specify)

For the following list of questions, please answer based on your personal use.

*

2.

Have you been tested for celiac disease, and what were the results?

Yes — Positive for celiac disease

Yes — Negative for celiac disease

Yes — Inconclusive

No — I have not been tested

Unsure

*

3.

. Which best describes you?

Undiagnosed celiac disease

Non-celiac gluten sensitivity

Wheat allergy

Avoid gluten for other reasons

Other: (please specify)

Not sure

*

4.

What is your age range?

5.

What is your gender? (Optional)

Male

Female

Non-binary

Prefer to self describe:

Prefer not to answer

Your Experience-- Gluten and GliadinX

*

6.

What negative symptoms from gluten or gluten cross-contamination do you typically notice?
(Select all)[Checkboxes]

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Nausea/Vomiting

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (please specify):

I normally don't experience noticeable symptoms.

*

7.

Which negative symptoms experienced from gluten or gluten cross-contamination go away when using GliadinX?
(Select all)[Checkboxes]

This question is selected from the previous question, please answer in order.

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Nausea/Vomiting

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (please specify):

I normally don't experience noticeable symptoms.

*

8.

When not using GliadinX, how confident and at ease did you feel when eating out in situations where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

9.

While using GliadinX, how confident and at ease do you feel when eating out in situations where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

10.

When using GliadinX in situations where gluten cross-contamination may occur, how would you describe your overall experience (confidence in eating and symptom reduction)?

Much better

Somewhat better

About the same

Worse

Unsure

*

11.

How often do you use GliadinX?

Daily

A few times a week

Once a week

1-3 times a month

Less than once a month

Other (please specify):

*

12.

In what situations do you use GliadinX? (check all that apply)[Checkboxes]

Restaurants

Eating food prepared by others

Traveling

Home

As a precaution with most meals

Other (please specify):

For the following list of questions, please answer based on your child.

*

13.

Has your child been tested for celiac disease, and what were the results?

Yes — Positive for celiac disease

Yes — Negative for celiac disease

Yes — Inconclusive

No — My child has not been tested

Unsure

*

14.

. Which best describes your child?

Undiagnosed celiac disease

Non-celiac gluten sensitivity

Wheat allergy

Avoid gluten for other reasons (please specify)

Not sure

*

15.

How old is your child?

*

16.

What is your child's gender? (Optional)

Male

Female

Non-Binary

Prefer to self describe:

Prefer not to answer

Your Child's Experience-- Gluten and GliadinX

*

17.

What negative symptom(s) from gluten or gluten cross-contamination does your child typically notice?
(Select all)[Checkboxes]

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Naseau/Vomiting

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (Please specify):

My child normally doesn't experience noticeable symptoms.

*

18.

Which negative symptom(s) your child experienced from gluten or gluten cross-contamination go away when using GliadinX?
(Select all)[Checkboxes]

This question is selected from the previous question, please answer in order.

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Naseau/Vomiting

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (Please specify):

My child normally doesn't experience noticeable symptoms.

*

19.

When not using GliadinX, how confident and at ease did your child feel eating out in situations where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

20.

While using GliadinX, how confident and at ease does your child feel eating out where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

21.

When using GliadinX in situations where gluten cross-contamination may occur, how would you describe your child's overall experience (confidence in eating and symptom reduction)?

Much Better

Somewhat Better

About the Same

Worse

Unsure

*

22.

How often does your child use GliadinX?

Daily

A few times a week

Once a week

1-3 times a month

Less than once a month

Other (please specify):

*

23.

In what situations does your child use GliadinX? (check all that apply)[Checkboxes]

Restaurants

Eating food prepared by others

Traveling

Home

As a precaution with most meals

Other (please specify):

You indicated that you purchase GliadinX for a family member other than your child. With that person in mind, please complete the following questions.

*

24.

Has your family member that uses GliadinX been tested for celiac disease, and what were the results?

Yes — Positive for celiac disease

Yes — Negative for celiac disease

Yes — Inconclusive

No — My family member has not been tested

Unsure

*

25.

. Which best describes your family member that uses GliadinX?

Undiagnosed celiac disease

Non-celiac gluten sensitivity

Wheat allergy

Avoid gluten for other reasons (please specify)

Not sure

*

26.

How old is your family member using GliadinX?

27.

What is the gender of your family member using GliadinX? (Optional)

Male

Female

Non-Binary

Prefer to self describe:

Prefer not to answer

Your Family Member's Experience with Gluten and GliadinX

*

28.

What negative symptom(s) from gluten or gluten cross-contamination do your family member typically notice?
(Select all)[Checkboxes]

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (please specify):

No noticeable symptoms experienced

*

29.

Which negative symptom(s) your family member experienced from gluten or gluten cross-contamination go away when using GliadinX?
(Select all)[Checkboxes]

This question is selected from the previous question, please answer in order.

Diarrhea

Constipation

Bloating/Gas

Abdominal pain or cramping

Fatigue/Low energy

Headaches or migranes

Brain fog/Difficulty concentrating

Skin rash

Bone or joint pain

Mouth ulcers

Anxiety

Other(s) (please specify):

No noticeable symptoms experienced

*

30.

When not using GliadinX, how confident and at ease did your family member feel eating out in situations where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

31.

While using GliadinX, how confident and at ease does your family member feel eating out where gluten cross-contamination may occur?

Not Confident

Very Confident

1
2
3
4
5

*

32.

When using GliadinX in situations where gluten cross-contamination may occur, how would your family member describe their overall experience (confidence in eating and symptom reduction)?

Much better

Somewhat better

About the same

Worse

Unsure

*

33.

How often does your family member use GliadinX?

Daily

A few times a week

1-3 times a month

Less than once a month

Other (please specify):

34.

You indicated that you have purchased GliadinX for someone other than a family member, and we are interested in learning about their experience with GliadinX. If you are willing, please share their email with us. (Optional)



Purchase Behavior

*

35.

Have you purchased GliadinX more than once?

Yes

No

*

36.

Do you plan to purchase GliadinX again?

Yes

Likely

Unsure

Unlikely

No

*

37.

What prevented you or will prevent you from purchasing again?[Checkboxes]

Price

Didn't notice difference

Found alternative

Availability

Other:

*

38.

Would you recommend GliadinX to a friend that you know is trying to maintain a gluten-free diet?

Absolutely Not Recommend

Absolutely Recommend

1
2
3
4
5

Your Voice

39.

In your own words, how has GliadinX impacted your lifestyle (if at all)? (optional)

40.

Is there anything else you would like to share with us? (optional)

If you would like us to respond, please include your name and email.

Thank you for taking a few minutes to share your experience!

GliadinX is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider regarding celiac disease or gluten-related conditions.

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