Symptoms and Conditions Checklist

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Most people with celiac disease are undiagnosed.   This checklist helps you document if you or your child have any of the common symptoms or conditions.  Share your checklist responses with your physician to determine if you or your child should have the celiac disease panel blood test.

This checklist is NOT a self-diagnosis tool. Diagnosis of celiac disease requires a celiac disease panel blood test and an endoscopic biopsy of your small intestine.

You MUST be eating gluten in order for the celiac disease panel test to be accurate as it measures your body’s reaction to gluten. A proper diagnosis can only be made by a physician.

INSTRUCTIONS: For you or your child, select the symptoms and conditions that apply and their frequency where indicated.  Hover your mouse over each blue tool tip icon for a more detailed description.

 
  • This checklist is designed for you to share with your physician the common symptoms and conditions of celiac disease that you or child may have. This checklist is NOT a self-diagnosis tool. Diagnosis of celiac disease requires the celiac disease panel blood test and an endoscopic biopsy of your small intestine. You MUST be eating gluten (wheat, rye or barley) in order for the celiac disease panel to be accurate as it measures your body’s reaction to gluten. Do NOT start a gluten-free diet until you have been diagnosed. A proper diagnosis can only be made by a physician.

 

General Conditions

 

Behavioral or Central Nervous System Conditions

 

Gastrointestinal Conditions

 

Muscular Skeletal Conditions

 

Reproductive Conditions

 

Skin and Dental Conditions

 

Other Conditions and Autoimmune Disorders

 

Family Member

 

Diet

 

Next Steps

 

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