Patient Candidacy Screening · Digestive Wellness Institute
Digestive Wellness Institute · A Center for Autoimmune Gastroparesis
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Patient Candidacy Screening

Find out if our Gastroparesis Care Program may be right for you.

Answer five short questions to help us understand your situation. This takes about two minutes, and a care coordinator reviews every response in collaboration with your primary physician.

Takes about 2 minutes
Reviewed by a coordinator
No obligation

Thank you, your screening has been received.

A care coordinator will review your responses and reach out within one business day. If your situation is urgent, please call us at (800) 555 0000 or contact your physician.

Based on your responses, you may be a candidate.

1
Download your lab requisition. Print it and bring it to your appointment.
Download Lab Requisition
2
Take it to your primary care provider to order the blood work that determines your Center of Excellence candidacy.
3
Send us your results. Once your blood work is back, have your provider's office send the results to our results inbox or secure eFax .

For your privacy, ask your provider's office to send results through a secure, encrypted channel (eFax or encrypted email) rather than standard email.

We've also emailed a copy of the requisition and these instructions to the email address you provided.

Patient Candidacy Screening

Please answer all questions below to help us determine if you may be a candidate for our program, in collaboration with your primary physician.

1 Have you been diagnosed with any of the following?

Select all that apply.

2 Do you experience any of the following conditions or symptoms?

Select all that apply.

3 Have you had a gastric emptying study (GES) performed?
4 Are you currently under the care of a gastroenterologist or digestive health specialist?
5 Do you regularly experience symptoms such as nausea, vomiting, bloating, or feeling full very quickly that impact your daily life?

Where should we send your results?

A coordinator will use this to follow up about your screening. We never share your information.

Your information is kept private and used only to coordinate your care.

This screening form is for informational purposes only and does not constitute medical advice or a diagnosis. Results are a preliminary indication only. A qualified healthcare provider will make all final determinations regarding your care.

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Digestive Wellness Institute
A Center for Autoimmune Gastroparesis

Advanced, coordinated care for complex, autoimmune gastroparesis.

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The Digestive Wellness Institute provides this website for general educational purposes. It is not medical advice and does not replace consultation with a qualified physician. This screening tool produces a preliminary indication only and is not a diagnosis. Infusion-based therapies, including intravenous immunoglobulin (IVIG), may not be appropriate for every patient; candidacy and treatment are determined through individual clinical evaluation. Insurance coverage varies by carrier and individual plan, and verification of benefits does not guarantee payment.
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