Celiac Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
Celiac Disease Symptoms
Celiac Disease Risks
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Do you frequently experience abdominal pain or discomfort?
*
Yes
No
Do you often have bloating or gas?
*
Yes
No
Have you noticed a change in your bowel habits (such as chronic diarrhea or constipation)?
*
Yes
No
Have you unintentionally lost weight recently?
*
Yes
No
Do you often feel fatigued or tired, even after getting enough sleep?
*
Yes
No
Do you have a family history of celiac disease or another autoimmune disease?
*
Yes
No
Have you been diagnosed with anemia of an unknown cause?
*
Yes
No
Do you have a skin rash that doesn’t seem to heal (such as dermatitis herpetiformis)?
*
Yes
No
Have you experienced unexplained dental enamel defects or oral ulcers?
*
Yes
No
Do you have unexplained bone or joint pain?
*
Yes
No
Celiac Disease Symptom Score
Celiac Disease Risk Score
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