Dysphagia
June is Dysphagia Awareness Month.  I want to write an article on this to share people's personal stories mixed with research on my blog.

My email address is: emilysstomach@gmail.com if you would like to email your story and/or pictures.

I just wanted to ask some questions because I do have personal experience with dysphagia, but wanted to include other people's experiences because it might reach someone who is going through the same thing that might not know what dysphagia is.
Sign in to Google to save your progress. Learn more
Email *
Dysphagia Information
When did you realize you had Dysphagia? *
What were your symptoms? *
When were you diagnosed? *
How were you diagnosed? What tests did you have to do? *
What did the doctors do for you in the way of treatment? *
What kind of Dysphagia do you have?  Esophageal Dysphagia? Oropharyngeal Dysphagia? *
Do you know what the cause of your Dysphagia was? *
Do you have any advice for people who may have just been diagnosed with Dysphagia? *
Do you have Gastroparesis as well? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms