We want to hear from you! Please complete the survey below. The purpose of this survey is to find out what you think about upper GI symptoms and ARDs. Understanding how you are managing your symptoms can help us understand your needs better. It should only take a couple of minutes to complete the survey. Participation in this survey is optional.

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  1. How often do you experience upper GI symptoms? These symptoms include abdominal pain or discomfort, heartburn (a burning feeling rising from your stomach or lower chest towards your neck); sour taste in mouth/acid regurgitation, excessive burping/belching, increased abdominal bloating, nausea and early satiety (feeling full just after eating or not able to finish meals).

    • At least once a day
    • 5-6 times per week
    • 3-4 times per week
    • 1-2 times per week
    • 1-2 times per month
    • Never

  2. How do you currently treat your upper GI symptoms disease? (Select all that apply)

    • Prescription medications
    • Over-the-counter medications (medications purchased without a prescription)
    • Both prescription and over-the-counter medications
    • Dietary changes (e.g. avoiding certain foods)
    • Lifestyle changes (e.g. sleeping with head elevated; limit stress etc)
    • Alternative medicines
    • Don’t treat

  3. How often do you treat your upper GI symptoms with prescription medication?

    • Twice a day
    • Once a day
    • 5-6 times per week
    • 3-4 times per week
    • 1-2 times per week
    • 1-2 times per month
    • Never

  4. How often do you treat your upper GI symptoms with over-the-counter medications (medications purchased without a prescription)?

    • More than once a day
    • Once a day
    • 5-6 times per week
    • 3-4 times per week
    • 1-2 times per week
    • 1-2 times per month
    • Never

  5. What is your age range?

    • Under 25
    • 25-40
    • 41-50
    • 51-60
    • 61-70
    • 70+
    • Prefer not to answer

  6. On a scale of 1 to 5, how would you rate your current level of knowledge of upper GI symptoms and acid-related diseases?

    Not very good   Average   Excellent
    1 2 3 4 5

  7. How likely are you to discuss your upper GI symptoms with your doctor?

    • I am very likely to discuss my symptoms with my doctor
    • I might discuss my symptoms with my doctor
    • I am not at all likely to discuss my symptoms with my doctor
    • I don’t know

  8. Yes, you can contact me from time to time for (check all that apply)

    • Market research and/or focus groups
    • Feedback about my experience with this information
    • So that I can share my story with others

Thank you for taking the time to complete this survey.

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