How are you currently being treated for moderate to severe Crohn’s disease?
(Select all that apply.)
REMICADE® (infliximab) is a registered trademark of Janssen Biotech, Inc.
Are you currently experiencing any of the following symptoms?
If you experience frequent bowel movements on your current treatment plan, how many times a day do they occur?
If you are changing your routine because of frequent soft or liquid stools, it may be a sign that your Crohn’s is active.
Have your bowel movements become more or less frequent since your last doctor’s visit?
If your bowel movements are becoming more frequent, it could mean a change in your condition. Be sure to mention it to your doctor.
If you are experiencing abdominal pain, how would you describe the severity?
Abdominal pain is a common symptom of Crohn’s; experiencing symptoms or changes in your symptoms are clues that can help your doctor evaluate your treatment plan.
Over the past 3 months, have you changed your diet or started avoiding certain foods or meals on your current treatment plan?
If you’ve altered your diet to try to manage Crohn’s flare-ups, it might mean a change in your condition. So even if your appetite or diet changes are small, it’s a good idea to mention them to your doctor to see if changes in your treatment plan are needed.
Overall, how does Crohn’s disease impact your day-to-day?
Are you familiar with how inflammation contributes to your Crohn’s symptoms?
Inflammation is a normal part of the body’s defense to injury or infection caused by bacteria, fungi, and viruses. But with Crohn’s, your immune system becomes overactive and attacks the GI tract, which can lead to a cycle of more inflammation, symptoms, and GI tract damage.
Has your doctor talked to you about the results of your endoscopies or the condition of your gastrointestinal tract?
An overactive immune system can cause inflammation in your GI tract, contributing to Crohn’s symptoms. Reducing inflammation from Crohn’s can help the GI tract visibly improve, called endoscopic improvement. This is one of the ways your doctor can evaluate how well your treatment is working.
How often do you use steroids to help control Crohn's disease symptoms?
Are you currently in steroid-free remission?
It’s important for your doctor to know how you are doing on your current treatment. Talk with your gastroenterologist about what remission without steroids can look like and what it would mean for you.
Are you ready to talk to your gastroenterologist about a treatment option that goes beyond symptom relief to treat excess inflammation that can contribute to your Crohn’s symptoms?
Being proactive in having a conversation with your doctor may identify a treatment plan to help you reach your goals.
Well done!
Bring your results to your doctor appointment to help you:
Please provide appropriate value in each field's default value property as per Analytics Tech Specs
Form Name:
Form Category:
Account Management, Contact, Interactions, Quiz, Registration, Services
Form Sub-Category:
Password Resets, Login, Profile, Representative, Contact Us, Polls, Social Share, Doctor Discussion Guide, Dosing Guide, Symptom Checker, Knowledge Assessment, Event, More Info, Sign Up, Saving Card, Benefit Verification, Benefit Enrollments, Medical Exception, Injection Form, Share a Story
Form MVA Name:
Form MVA Type:
Download, Form, Link, Share, Tool, Video
Form MVA Tier:
Form MVA Category:
Savings Card, Insurance, Symptom Journal, Test Score Tracker, Condition Information, Doctor Discussion Guide, Dosing Information, Enrollment Form, Flashcard, Medical Exception, Patient Counseling Guide, Savings Card, Symptom Journal, Doctor Discussion Guide, Doctor Search, Dosage Calculator, Enroll, Med Reminders, Quick Poll, Resource Request, Symptom Quiz, UGC Submission, Contact Rep, Savings Card, Social Share, App Store, More Info, Patient Resources, Share Information, Share Results, Submit a Story, Assessment Tool, Benefits Verification, Carousel, Initiation, Myth versus Fact, Workaround Quiz, Formulary Tool, Image Expand, Medical Exception, Q And A, Slider, Administration Instructions, Condition Information, Insurance, Inventory, Mechanism of Action, Patient Story, Product Overview, Program Overview, Injection Training, Other
Form PII Field Names for Masking:
Form MVA Initialize QA:
Form Analytics Payload: