Most people with celiac disease are undiagnosed. This checklist helps you document for your physician if you or your child
have any of the common symptoms or conditions of celiac disease.
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.