# EoE Patient Perspectives — Short Survey

*Draft for informal distribution to friends and peers with eosinophilic esophagitis (EoE), in support of a tolerizing-vaccine concept.*

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## Intro / consent text (paste at top of the form)

> **Thanks for helping!** This is a short (~5 minute), completely **anonymous** survey about living with eosinophilic esophagitis (EoE) and how you feel about current and future treatments. Your answers will help shape a research idea for a new kind of EoE therapy.
>
> - Participation is **voluntary** — skip any question you'd rather not answer.
> - **No names, emails, or identifying information** are collected.
> - This is an informal survey, **not a research study or medical advice**, and nothing here changes your care. For any medical decisions, talk to your own doctor.
>
> By continuing, you're agreeing to take part. Thank you!

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## Section 1 — A little context (single click)

**Q1. How long ago were you diagnosed with EoE?**
- Less than 1 year
- 1–3 years
- 3–5 years
- 5–10 years
- More than 10 years

**Q2. How is your EoE currently managed?** *(select all that apply)*
- Proton-pump inhibitors (e.g., omeprazole)
- Swallowed / topical steroids (e.g., budesonide, fluticasone)
- Dietary elimination (e.g., dairy-free, 6-food elimination)
- A biologic injection (e.g., dupilumab / Dupixent)
- Esophageal dilation procedures
- No treatment right now
- Other

**Q3. Do you know or suspect specific food triggers?** *(select all that apply)*
- Milk / dairy
- Wheat / gluten
- Egg
- Soy
- Nuts
- Fish / shellfish
- Not identified / unknown
- Other

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## Section 2 — Living with EoE today (single click)

**Q4. Overall, how much does managing EoE interfere with your daily life?**
`1 — Not at all  →  5 — A great deal` (1–5 scale)

**Q5. Which parts of managing EoE are most burdensome for you?** *(select up to 3)*
- Restricting or avoiding foods
- Taking daily medication
- Repeat endoscopies / biopsies
- Cost / insurance
- Symptom flares (trouble swallowing, food getting stuck, pain)
- Food-related anxiety or social impact
- Other

**Q6. How satisfied are you with your current treatment options?**
`1 — Very dissatisfied  →  5 — Very satisfied` (1–5 scale)

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## Section 3 — A new kind of treatment (single click)

> *Researchers are exploring treatments that would gently retrain your immune system to **tolerate** the foods that trigger EoE — the goal being fewer symptoms and less need for lifelong diet restriction or daily medication. The next questions ask how you'd feel about an approach like this.*

**Q7. How interested would you be in a treatment that retrains your immune system to tolerate your trigger foods?**
`1 — Not at all interested  →  5 — Extremely interested` (1–5 scale)

**Q8. Would you be open to receiving such a treatment as an injection or short series of injections?**
- Yes
- Maybe / depends
- No

**Q9. What would most influence your decision to try a new immune-based treatment?** *(select up to 3)*
- Safety / side effects
- How well it works
- Being able to eat trigger foods again
- Reducing or stopping daily medication
- Fewer endoscopies / procedures
- My doctor's recommendation
- Cost / insurance coverage
- Other

**Q10. If a new treatment worked well, which outcome would matter most to you?** *(pick one)*
- Being able to eat foods I currently avoid
- Stopping daily medication
- Fewer endoscopies / procedures
- Fewer symptoms and flares
- Less anxiety around food
- Other

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## Section 4 — In your words (optional, the one short-answer question)

**Q11.** *In a sentence or two:* **what would an ideal EoE treatment do for you that your current options don't?**
`[ open text ]`

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## Optional (helps with context, keep optional)

**Q12. Age range** *(optional)* — Under 18 · 18–29 · 30–44 · 45–59 · 60+ · Prefer not to say

*(If any respondents may be under 18, consider limiting to adults or noting that a parent/guardian should complete it, since minors' health data carries extra sensitivity.)*