Project PREVENT Survey

Do you have IBD? Are you interested in preventive health measures? Please complete this 8 question survey to receive personalized preventive health video messages.

1. What is your age?

    <18

    18-49

    50-64

    65+

2. Do you have inflammatory bowel disease (Crohn’s disease, ulcerative colitis or indeterminate colitis)?

    Yes

    No

    Don't know

3. Are you...?

    Male

    Female

4. Are you currently taking any of the following classes of medications (check all that apply)?

    Anti-tumor necrosis factor alpha (Remicade/Infliximab, Humira/Adalimumab, Cimzia/Certolizumab Pegol, Simponi/Golimumab)

    Janus Kinase inhibitor (Xeljanz/Tofacitinib)

    Interleukin 12/23 inhibitor (Stelara/Ustekinumab)

    Anti-adhesion molecule (Entyvio/Vedolizumab)

    Thiopurine (6MP/Purethinol, azathioprine/Imuran)

    Methotrexate

    I am not taking any of these medications

5. Have you ever taken steroids (prednisone, solumedrol, deltasone) for at least 3 months duration in your lifetime?

    Yes

    No

    Don't know

6. Have you had any of the following vaccines (check all that apply)?

    Pneumonia (pneumococcal – Prevnar 13 and/or Pneumovax)

    Shingles/herpes zoster (Shingrix or Zostavax)

    Influenza/flu (for the current flu season)

    I have not had any of these vaccines

7. Have you had a skin examination by a dermatologist to screen for skin cancer within the past year?

    Yes

    No

    Don't know

8. Have you ever had a bone density scan to assess your bone health?

    Yes

    No

    Don't know

Thank you for completing our brief prevention survey. You will now be directed to your personal prevention messages. Please discuss these recommendations with your physician to see if they are right for you.