--- title: Celiac Disease Screening Questionnaire Form Template | Paperform description: Professional celiac disease screening form with symptom assessment, family history evaluation, serologic testing consent, and dietary consultation requests for healthcare providers. url: "https://paperform.co/templates/celiac-disease-screening-questionnaire" type: static generatedAt: "2026-04-04T00:43:23.476Z" --- [← Back to free form templates](/templates/) ![Celiac Disease Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/celiac-disease-screening-questionnaire.png) [Preview](https://_preview.paperform.co/ai-template/celiac-disease-screening-questionnaire) [Use this template for free](/create?ai-template=celiac-disease-screening-questionnaire) [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Dietitian](/templates/role/dietitian/) About this free form template ### Screen for Celiac Disease with a Professional Digital Questionnaire Celiac disease affects approximately 1 in 100 people worldwide, yet many cases remain undiagnosed for years. Early detection through systematic screening can prevent serious complications and improve patient outcomes. This **Celiac Disease Screening Questionnaire** template provides healthcare providers, gastroenterology practices, and wellness clinics with a structured digital form to assess patient risk factors, document symptoms, and streamline the path to diagnosis. #### Comprehensive symptom and risk assessment This template guides patients through a detailed evaluation of gastrointestinal symptoms, extraintestinal manifestations, and family history—all key indicators for celiac disease screening. By collecting this information upfront, healthcare providers can better identify high-risk individuals who warrant serologic testing and further evaluation. #### Seamless consent and follow-up coordination The form includes built-in consent sections for serologic testing and offers patients the option to request dietary consultations with specialists. This reduces administrative back-and-forth and helps coordinate the next steps in the diagnostic and management process. #### Built on Paperform for healthcare workflows Paperform makes it easy for medical practices to create professional, GDPR-compliant forms that patients can complete on any device. With conditional logic, you can tailor follow-up questions based on symptom severity or family history. Submissions can be automatically routed to your practice management system, EHR, or team communication tools via integrations with Google Sheets, Airtable, Slack, or through custom webhooks. For practices looking to automate post-submission workflows—such as scheduling follow-up appointments, sending patient education materials, or flagging high-risk cases for urgent review—**[Stepper](https://stepper.io)** can trigger multi-step processes based on form responses, keeping your care coordination smooth and efficient. This template is trusted by gastroenterology clinics, primary care practices, and wellness centers looking to improve early detection of celiac disease while maintaining a professional, patient-centered experience. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Atrial Fibrillation Screening & Stroke Risk Assessment](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/atrial-fibrillation-screening-stroke-risk-assessment.png) ### Atrial Fibrillation Screening & Stroke Risk Assessment Comprehensive AFib screening form for high-risk patients including pulse assessment, ECG ordering, CHA₂DS₂-VASc stroke risk calculation, and cardiology consultation scheduling.](/templates/atrial-fibrillation-screening-stroke-risk-assessment/) [![Achalasia Screening 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