Gluten Free Casein Free Diet Questionnaire - Have tried it, but no longer using it
Answers marked with a * are required.
1.
Parent Survey - Have tried it, but no longer using it
1.
Why did you stop using the GFCF diet? (choose the strongest reason)
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I didn't see a significant improvement in my child's life by a diet change.
The GFCF diet was too expensive.
The ingredients and foods for the GFCF diet were very difficult to find.
The ingredients and foods for the GFCF diet did not taste good.
My child would not eat the foods that were required by the GFCF diet.
Other (Please Specify)
2.
Where did you get ingredients and foods for you child while he/she was on the GFCF diet? (choose all that apply)
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Neighborhood grocery store.
Health food grocery store (i.e., Whole Foods, Trader Joe's, etc.)
Internet supplier
Other (Please Specify)
3.
Did you notice any significant changes while he/she was on the GFCF diet? (choose all that apply)
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Increase in attention span.
Increase in communication.
Decrease in problem behaviors.
Decrease in difficult or abnormal bowel movements.
Decrease in self-injurious behavior.
No significant change.
Other (Please Specify)
4.
Have you considered going back on the GFCF diet? Why or why not?
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5.
If you were to put your child back on the GFCF diet, what changes would need to be made in order to continue doing it?
6.
What foods does your child commonly eat?
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7.
Would you like us to contact you about the potential to have GFCF foods and ingredients available for delivery or pick up in your area? If so, please type your e-mail address in the space below.
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