Note & Discuss Your Symptoms

How many times have you had to refill your prescription of steroids in the last year?
(Question 1 of 6)

How often do you currently take steroids to control flare-ups, as prescribed by your doctor?
(Question 2 of 6)

How many bowel movements do you have a day?
(Question 3 of 6)

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  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
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  • 9
  • 10+

These could be common symptoms of ulcerative colitis (UC) or Crohn's disease (CD): how often do you experience any of the following symptoms?
(Question 4 of 6)

Never
Occasionally
Sometimes
Often
Always
Abdominal pain or cramping
Never
Occasionally
Sometimes
Often
Always
Diarrhea
Never
Occasionally
Sometimes
Often
Always
Rectal bleeding
Never
Occasionally
Sometimes
Often
Always
Accidents
Never
Occasionally
Sometimes
Often
Always
Constipation
Never
Occasionally
Sometimes
Often
Always
Straining during bowel movements
Never
Occasionally
Sometimes
Often
Always
Lack of energy
Never
Occasionally
Sometimes
Often
Always
Yes
No
Weight loss
Yes
No

Please indicate how you feel using the following scale:
(Question 5 of 6)

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  • Terrible
  • Okay
  • Good

Are your current treatments working well enough?
(Question 6 of 6)

Congratulations!

You've taken an important first step toward having a discussion with your doctor.

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