Get a personalized discussion guide that's tailored to you—and your gut.

Talking about your ulcerative colitis or Crohn’s disease with your doctor isn't always fun, but this guide can make it a little easier.

Just answer a few questions about your symptoms and day-to-day experience, and you'll get a custom guide that can help you get the most out of your next doctor visit.

What to expect:

What to expect:

5 to 8 minutes

Questions about physical and emotional symptoms

Get your custom, downloadable guide

Your privacy is important to us. Your responses will not be shared or stored, or used for any purposes other than creating this guide.

US-NON-9280v2.0 09/23

First up, tell us your name.

Hi [NAME]! Now, which disease have you been
diagnosed with?

Please select an answer

We know living with [DISEASE] can be tough. Let's dig into your personal experience, so we can better understand what it’s like for you.

How long since you were diagnosed with [DISEASE]?

Please select an answer

What medicines have you used to treat your [DISEASE] symptoms?

Select all that apply.

Please select an answer

Right now, how is managing your [DISEASE] going?

Please select an answer

Thanks [NAME], that’s helpful! Ok, now let’s get into the nitty gritty details about your physical symptoms. The more honest you are, the more helpful your guide will be!

How would you describe your symptoms?

Select all that apply.

Please select an answer

How bad is your pain?

Please select an answer

How often do you have a flare? i A flare is a period of time when your symptoms are acting up.

Please select an answer

When you have a flare, how long does it usually last?

Please select an answer

When you have a flare, how frequent are your bowel movements?

Please select an answer

Alright, we’re starting to get a good picture of how your [DISEASE] is affecting you physically. Now, let’s dig into how it’s affecting your emotional state.

On a scale of 1 to 5, how much do you worry about your [DISEASE]?

1 2 3 4 5

1 – I don’t think about it much

2 – Occasionally, but it’s not top of mind

3 – I worry a good amount

4 – It’s almost always on my mind

5 – I’m constantly worried about what could happen

Please select an answer

How do your symptoms make you feel?

Select all that apply.

Please select an answer

Fill in the blank. Because of my symptoms, I have .

Select all that apply.

Please select an answer

How often have you

Packed an extra set of clothes?

Missed work or event?

Decided not to travel?

Avoided eating?

Scoped out bathrooms before or during a trip?

Felt left out or alone?

Please select an answer

Great! That’s all we need to know about your physical symptoms and emotional health. Now, just a few more questions before you’re done.

What worries you the most about your [DISEASE]?

Please select an answer

What is your goal for managing your [DISEASE]?

Select all that apply.

Please select an answer

Got any questions for your doctor? Enter them here and they'll be included in your guide!

Great work!
You're all done, [NAME].
Now, let’s take a look at your one-of-a-kind gut guide.

My gut guide

[NAME]'s Gut GuideWith this personalized guide in hand, you're ready to make the most out of your next doctor visit. And remember, there are always more resources available to you at LivingWithIBD.com.

It’s time to think about the future

It’s good to hear that your [DISEASE] is pretty manageable at the moment. But remember, [DISEASE] can cause permanent damage to your gut, so now might be a good time to start thinking about ways to manage your disease moving forward.

Make sure to have a serious discussion about your current symptoms and potential treatment options with your doctor. Together, you can be ready for what your [DISEASE] brings in the future.

A little improvement could go a long way

It sounds like you’re managing your [DISEASE] pretty well at the moment, but that doesn’t mean it isn’t impacting your life.

Little things, like nagging symptoms or disruptions in your day-to-day life, could get worse over time. There may be ways to help reduce your symptoms, and your doctor can help you find what works for you.

You're not the only one struggling

There are a lot of people out there struggling with [DISEASE], and from your answers, it sounds like you could be one of them.

Take a minute to think about all the ways your [DISEASE] is affecting you, physically and emotionally. How would your life change if your [DISEASE] was better controlled? Your doctor can help you explore management options that may help you reach your goals.

You're ready to make a change

From your answers, it sounds like you're really struggling with your symptoms and how much your [DISEASE] is affecting your everyday life.

It’s important to remember that you're not alone. Millions of people in the US have IBD, and there are treatments that may be able to help. Make sure you tell your doctor just how much your [DISEASE] is affecting you, and they might be able to help you make a real change.

My Top Conversation Starters

Based on your answers, here are some important topics you should definitely bring up to your doctor.

  • My #1 concern: 
  • Pain is a real problem
  • Flares mean LOTS of trips to the bathroom
  • I'm constantly worrying about my disease
  • My flares happen 
  • When I have a flare, it usually lasts 
My gut guide

DIAGNOSIS: [DISEASE]

Time since diagnosis:

Treatments I've tried:

How is managing my disease going?

Created by [NAME] at LivingWithIBD.com
My gut guide

Physical Symptoms

How would I describe my symptoms?

How bad is my pain?

How often do I have flares?

How long do my flares usually last?

When I have a flare, how frequent are my bowel movements?

Created by [NAME] at LivingWithIBD.com
My gut guide

EMOTIONAL HEALTH

How much do I worry about my disease?

1 2 3 4 5
I worry a good amount

How do my symptoms make me feel?

Because of my symptoms, I have ___

Created by [NAME] at LivingWithIBD.com
My gut guide
Created by [NAME] at LivingWithIBD.com
My gut guide

KEY TAKEAWAYS

What worries you the most about your ?

What is my goal for managing my ?

Don't forget to ask these questions!

NOTES

Created by [NAME] at LivingWithIBD.com
My gut guide

NOTES

©2023 Takeda Pharmaceuticals U.S.A., Inc. All rights reserved. Printed in U.S.A. US-NON-9280v2.0 09/23

Created by [NAME] at LivingWithIBD.com

How often have I packed an extra set of clothes

How often have I missed work or an event

How often have I decided not to travel?

How often have I avoided eating?

How often have I scoped out bathrooms before or during a trip?

How often have I felt left out or alone?