Skip to main content

MODULATE Self-Screening

Date

The questionnaire below asks a few simple questions to find out whether you may be suitable to take part in the MODULATE trial.

Please answer each one by clicking either the Yes or No button.

Once you have completed all the questions, click the Submit button and your answers will be processed.

Are you over 18 and live in the UK?

Do you suffer from ulcerative colitis?

Have you been told your disease is currently stable but, despite this, your condition still causes you frequent, troublesome diarrhoea?

Have you ever tried to treat your ulcerative colitis with regular use of the following treatments, but this didn’t seem to help relieve your symptoms?
(tick all that apply)

Do you have any known allergies to:
(tick all that apply)