Digestive Center · A Center for Autoimmune Gastroparesis
Patient Candidacy Screening

Find out if our Gastroparesis Care Program may be right for you.

Answer five short questions to help us understand your situation. This takes about two minutes, and a care coordinator reviews every response in collaboration with your primary physician.

Takes about 2 minutes
Reviewed by a coordinator
No obligation

Thank you, your screening has been received.

A care coordinator will review your responses and reach out within one business day. If your situation is urgent, please contact your physician.

Based on your responses, you may be a candidate.

Watch for our confirmation email

A care coordinator reads every screening before we respond. If you are a match, we will email your lab form and what to do next, usually within one business day.

Please wait for that email before booking an appointment or visiting your physician.

What happens next

1
We review your screening. A coordinator reads your answers and decides whether our program is a fit.
2
We email you. If you are a candidate, that email confirms it and includes your lab form.
3
Give the form to your physician. Your doctor reviews it, orders the recommended blood work, and records your results directly on it.
4
Your physician sends it back to us. Ask your doctor's office to return the completed form, with your results, so our team can review it and reach out about next steps. They can send it by:

For privacy, please ask the office to return the form through a secure, encrypted channel (fax or encrypted email) rather than standard email.

Your form is ready if you want a copy now. Please still wait for our email before taking it to your physician.

Download my form

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Patient Candidacy Screening

Please answer all questions below to help us determine if you may be a candidate for our program, in collaboration with your primary physician.

1 Are you currently under the care of a gastroenterologist or digestive health specialist?
2 Have you been diagnosed with any of the following?

Select all that apply.

3 Do you experience any of the following conditions or symptoms?

Select all that apply.

4 Do you regularly experience symptoms such as nausea, vomiting, bloating, or feeling full very quickly that impact your daily life?
5 Have you had a gastric emptying study (GES) performed?

Where should we send your results?

A coordinator will use this to follow up about your screening. We never share your information.

Your information is kept private and used only to coordinate your care.

This screening form is for informational purposes only and does not constitute medical advice or a diagnosis. Results are a preliminary indication only. A qualified healthcare provider will make all final determinations regarding your care.