Having a list of your symptoms can be helpful when visiting your doctor. The answers to this survey will help you talk about your symptoms with your doctor when you Request the Test for celiac disease. The survey should only take about 5 minutes to complete.

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Use these survey answers to help you talk about your symptoms with your doctor.Remember, one symptom doesn't define celiac disease.
But one test can.

This survey is not a diagnosis. It is designed to help you talk to your doctor about your symptoms.

You indicated that you do not have any of the symptoms appearing on this survey. If you are experiencing any other symptoms that are concerning you, please talk with your doctor. If you would like to take the survey again, please click here.

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  • Question 1

    Do you have any of the common symptoms of Celiac Disease listed below? (Select all that apply)

  • Question 2

    Do you have any first-degree relatives with celiac disease? (Check all that apply)

  • Question 3

    Do you have any second-degree relatives with celiac disease? (Check all that apply.)

  • Question 4

    Have you had any of the following?

  • Question 5

    Do you have any of the following conditions? (Check all that apply)

    We noticed you didn’t answer any of the survey questions. To start over, click here. To learn more about the symptoms of celiac disease, click here.

 

Next: Requesting the Test

 

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