Dotazník spokojenosti s produktem ENTEROSGEL®

Contact Information

Please include your email for feedback

Your name and surname

Your country

Basic Use Details

1

ENTEROSGEL® has been used: (You can select multiple options)

Child <1 year

Child 1-6 years

Child 7-14 years

15+ adult

Pregnant woman

Breastfeeding woman

Adult over 60 years of age

2

For what condition did you use ENTEROSGEL®? (You can select multiple options)

Irritable bowel syndrome with diarrhoea (IBS-D)

Other IBS types: IBS-M/IBS-C/unspecified IBS

Acute diarrhoea

Use for drug or chemical poisoning

Chronic diarrhoea not diagnosed as IBS-D

Hyperazotemia (high urea or other nitrous molecules)

"Detox" or preventive use

Skin related uses such as atopic dermatitis, psoriasis, acne

Hyperbilirubinemia (high bilirubin)

Food poisoning or gastrointestinal infection

Septic infection

Allergies

Other

3

Was Enterosgel recommended to you by a physician?

I don't want to answer

Yes

No

Effectiveness

4

Has your ENTEROSGEL® therapy been effective?

1 = no effect

2 = slight improvement

3 = moderate improvement

4 = strong improvement

5 = symptoms resolved

5

How did ENTEROSGEL® affect your symptoms? Please answer only the items that are relevant to your condition.

Stool frequency

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

Stool consistency

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

Duration of diarrhoea

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

Abdominal pain

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

Bloating

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

Urgency

I don't want to answer

0 = no improvement

1 = slight improvement

2 = moderate improvement

3 = strong improvement

6

Please rate how much the symptoms for which you took ENTEROSGEL® interfered with your daily quality of life (work, study, social contacts, etc.) Rate on a 5-point scale, where 5 is maximum interference

Before starting treatment with ENTEROSGEL®

I don't want to answer

1 = Minimum

2 = Weak

3 = Moderately

4 = Strongly

5 = Maximum

After completing treatment with ENTEROSGEL®

I don't want to answer

1 = Minimum

2 = Weak

3 = Moderately

4 = Strongly

5 = Maximum

Safety and Side Effects

7

Have you experienced any side effects that you think might be related to the use of ENTEROSGEL®? (You can select multiple options)

No side effects

Constipation

Nausea

Increased fatigue or feeling unwell associated with poor nutrition/vitamin deficiency

Other

Administration Behaviour

8

How long did you continuously take ENTEROSGEL®?

Occasionally

1 - 7 days

8 - 30 days

More than 30 days

9

If you used ENTEROSGEL® for more than 30 consecutive days, was this under the advice of a healthcare professional?

Yes, by advice

No, self-administered

Did not use >30 days

10

Did you stop taking ENTEROSGEL® before the recommended time of use?

Yes

No

11

If you used the tube format (90g/225g), did you ensure the lid was closed tightly after each use?

I don't want to answer

Always

Mostly

Rarely

Never

Did not use tube

12

How did you measure the dose?

Teaspoon

Tablespoon

Sachet (single dose)

Other measurement device

Estimated visually

Did not measure

13

What type of water did you use when mixing ENTEROSGEL®?

Did not mix with water

Tap water (drinking quality)

Tap water (not drinking quality)

Bottled water

I mixed it with something else

Interactions

14

Did you take ENTEROSGEL® together with other intestinal adsorbents (e.g., activated charcoal, clay, kaolin)?

Yes

No

15

Did you take any other oral medications (including prescribed drugs, supplements, or vitamins) while using ENTEROSGEL®?

Yes

No

16

If yes, did you keep the recommended 2-hour interval?

Always

Mostly

Rarely

Never

Not applicable

17

Did you generally maintain the recommended 1-2 hour gap between taking ENTEROSGEL® and eating meals?

Always

Mostly

Rarely

Never

Storage & Environmental Conditions

18

How did you store ENTEROSGEL®? Select all that apply

Room temperature (4°C to 30°C range)

Fridge

Car (Potentially extremes/freezing <4°C or >30°C)

Near a heat source (Potentially >30°C)

Unknown

19

Did you use ENTEROSGEL® past the expiry date or past the 30-day "in-use" limit for opened tubes?

Yes

No

Unsure

20

If you used the sachet format (10x15g), did you reuse a partially used sachet?

Yes

No

Did not use sachets

Additional Questions

21

How do you perceive the taste/smell of ENTEROSGEL®:

I don't want to answer

Neutral (no taste/smell)

Noticeable but neutral

Pleasant

Unpleasant

22

How would you describe the consistency of ENTEROSGEL®?

I don't want to answer

Normal (as expected)

Thinner than usual

Thicker than usual

Lumpy / separated

Other

23

How likely are you to use ENTEROSGEL® again?

I don't want to answer

Very likely

Likely

Maybe

Unlikely

Definitely not

24

Do you have any additional comments, suggestions for improvement, or details regarding your experience?

Consent to the processing of personal data and the sending of commercial communications

The consent is granted in accordance with Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons in connection with the processing of personal data and on the free movement of such data.

I hereby grant consent to Bioline Products s.r.o. (Manufacturer), as the administrator of personal data, to process my personal data (including automated processing, such as collection, monitoring, profiling, evaluation, and storage). All data will be processed solely for the internal needs of the company, market analysis, and for identifying relevant needs of patients. The personal data processed on the basis of this consent are strictly limited to: e-mail, name and/or surname (if provided), and country (if provided).

I give this consent voluntarily and I am aware that I can revoke it at any time, in the same way as I granted.

ENTEROSGEL® User Questionnaire

Contact Information

Basic Use Details

Effectiveness

Safety and Side Effects

Administration Behaviour

Interactions

Storage & Environmental Conditions

Additional Questions

Consent to the processing of personal data and the sending of commercial communications