Study Control Group – Intake Form

Please fill out this form and click “Submit” at the bottom. Thank you!

If you have any questions, don’t hesitate to ask.

Your Control Group Participant Number:(required)

Gender(required) Male

Female

Date of Birth (month/day/year)(required)

Approx. date of MG Diagnosis (month and year or just year if you do not recall the month)(required)

Approx. what year did you become symptomatic? (We know many have symptoms of MG long before diagnosis.)(required)

Have you had a thymectomy?(required) Yes

Please list other conditions you currently have, other than MG. (examples: IBS, depression, Lupus, diabetes, neuropathy, etc.)(required)

Are you currently eating a gluten free diet?(required) Yes I eat gluten free

I try to reduce gluten but I am not gluten free

No I do not eat a gluten free diet

Do you feel that your MG symptoms (overall) have been progressive in nature?(required) Yes

On average, how would you describe the quality of your sleep?(required)

How would you describe the physical pain you deal with on a regular basis?(required)

Thank you so much for your time and participation in this study.

* This Site Does Not Provide Medical Advice *