FGID Clinic Questionnaires

FGID Clinic Questionnaire 

Please select the questionnaire/survey you were instructed to complete. Do
not hesitate to contact our office, should you have any questions or

Once you have completed the questionnaire/survey, please fax or email it to
the office.

Phone – (703) 281-1023
Fax – (571) 459-2226
Email -TBD

7-Point Bristol Stool Form Scale


IBS Assessment of Symptoms Questionnaire

Gastroparesis Cardinal Symptom Index

Functional Dyspepsia Quality of Life Survey

Functional Dyspepsia Weekly Symptom Survey (12 Weeks)

Irritable Bowel Syndrome with Diarrhea: Daily Symptom Survey

Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: Weekly Symptom Survey

GERD Health-Related Quality of Life (GERD-HRQL) Questionnaire