Coeliac Review

If you have been advised by the surgery to submit a coeliac review, please use this form.

Coeliac Review

Section

Are you under hospital care for your coeliac disease? *
You do not need to complete the rest of this questionnaire. Please do not submit this form.

Any problems / concerns with following a gluten free diet?
Do you get any symptoms from your coeliac disease at the moment? Please select the ones you have experienced: