J-Pouch Survey

J-Pouch Survey

ExeGi Pharma, the makers of the high potency probiotic Visbiome, are conducting a survey which is intended to help doctors better understand the personal experiences of those with a J-pouch who have experienced pouchitis or other problems associated with the J-pouch. Data from this survey will support ExeGi's efforts to develop a new live biotherapeutic agent intended for the prevention of pouchitis. This survey will take less than 10 minutes to complete.
Age*
Years
Gender*

MaleFemaleOther
How long have you had your J-pouch?*
# of Years
Where was your J-Pouch surgery performed?*
Please specify clinic/hospital - Location City
Institution Information - J-Pouch Surgery*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever been diagnosed with pouchitis?*

YesNo