Gluten Free Casein Free Diet Questionnaire - Use It Now
Answers marked with a * are required.
1.
Parent Survey - Use It Now
1.
Have you noticed any significant changes since he/she started 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)
2.
What struggles do you face in trying to maintain the diet? (choose the biggest struggle)
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Still waiting to see significant improvement in my child's life.
Too expensive.
The ingredients and foods for the GFCF diet are very hard to find.
The ingredients and foods don't taste good.
Finding foods that my child will eat.
Other (Please Specify)
3.
Where do you get your meals and/or ingredients? (choose all that apply)
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Neighborhood grocery store.
Organic/Natural foods store.
Internet supplier.
Other (Please Specify)
4.
Where do you get your recipes? (choose all that apply)
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Cookbooks I have purchased.
Online resources.
Modifying recipes on my own.
Don't have recipes.
Other (Please Specify)
5.
What ingredients or foods are hard for you to find?
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6.
Does your whole family eat the GFCF foods, or is the food exclusively for your child with autism?
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Whole family eats the GFCF foods.
GFCF foods are exclusively for my child with autism.
Other (Please Specify)
7.
What foods does your child commonly eat?
*
8.
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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