Pre-Screening Questions

How did you hear about us?  





What is your date of birth?
Please select your gender:

Have you been diagnosed with IBS by a doctor?




Do you experience abdominal pain?

Are you currently using, or have you used, opioids such as heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine, or cannabinoids such as medical or recreational marijuana, THC, CBD, or synthetic cannabinoids?

Are you currently taking any of the following medications?
  • Probiotics
  • Bulk laxatives such as: Benefiber, Metamucil, FiberCon, or Citrucel
  • Fiber
  • Stool softeners such as: Colace, Ex-Lax Stool Softener, or Surfak
  • Pepto-Bismol

Are you currently taking any medications for your IBS that are NOT listed below?
  • Probiotics
  • Bulk laxatives such as: Benefiber, Metamucil, FiberCon, or Citrucel
  • Fiber
  • Stool softeners such as: Colace, Ex-Lax Stool Softener, or Surfak
  • Pepto-Bismol


Have you had any colonic or major abdominal surgery? Examples include bariatric surgery (including gastric banding), having your gallbladder removed, stomach surgery, small/large bowel surgery or abdominal large vessel surgery.


Do you have a history of colorectal cancer, inflammatory bowel disease, diverticulitis, ischemic colitis, microscopic colitis, bile acid diarrhea, or celiac disease?


Do you have a history of any of the following diseases or problems?
  • Peptic ulceration
  • Functional dyspepsia
  • Gastrointestinal (GI) bleeding
  • Gastrointestinal (GI) inflammatory disease such as esophagitis, gastritis, or duodenitis


Do you have Type 1 or Type 2 Diabetes?


This study requires you to record some of your IBS symptoms in an eDiary (an electronic diary that captures data) every day throughout the study. Would you be willing to record your symptoms daily in order to participate in this study?


This study requires one overnight observation period at the study center to observe your response after the first day of taking the investigational treatment. Would you be willing to stay overnight at a study center in order to participate in this study?


If you choose to save your information, and we want to contact you in the future about the CAPTIVATE study, what is your preferred method of being contacted?
Please note, your preference will be taken into consideration, but we may contact you using any methods you provide (SMS, Phone, Email).