Jewish Digest - Buddy Form Be a Volunteer Buddy If you are a parent of a child with IBD, please fill in the questionnaire on behalf of your child and let us know how old your child is in the comments box. OK Question Title * 1. What is your age? 16-18 19-24 25-34 35-44 45-54 55+ age of child OK Question Title * 2. Are you male or female Male Female Is your child male or female? OK Question Title * 3. Do you (or your child) have Crohn's or Colitis? Crohn's Ulcerative Colitis Other (please specify) OK Question Title * 4. How severe is your (or your child's) IBD? Mild Moderate Severe OK Question Title * 5. Have you (or your child) had surgery? Yes No Other (please specify) OK Question Title * 6. Do you (or your child) have an ileostomy or colostomy? Yes No Other (please specify) OK Question Title * 7. Are you (or your child) taking medication that needs to be injected or administered as an infusion? Yes No Other (please specify) OK Question Title * 8. What is your availability like? Mornings Afternoons Evenings Weekends Other (please specify) OK Question Title * 9. How long have you (or your child) had IBD? Just diagnosed less than 2 years 2-4 years 5-10 years more than 10 years Other (please specify) OK Question Title * 10. Please leave your name, number and email address below and we will contact you! OK DONE