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Coeliac Disease Annual Review

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Personal Details

May be used to identify you

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Coeliac Review

Have you visited Coeliac UK for information/support?: *

Do you have any gastrointestinal symptoms?: *

Constipation, diarrhoea, abdominal pain or vomiting

Do you have any of the following?:

Please tick

Do you need any assistance sticking to a Gluten-free diet?: *

Do you need gluten-free food on prescription? :

Do you need advice from a dietician?:

Are you up to date with the following vaccinations?

Pneumococcal vaccine every 5 years :

Meningococcal A, C, W, Y vaccine:

For those born between 1995 and 2014

Flu vaccine:

COVID-19 vaccine:

Visit the NHS Lothian - Immunisations for information and to self-book vaccinations via the Lothian Vaccine Hub.

Do you have any concerns about your bone health or calcium intake?: *

Adults with coeliac disease should have at least 1000mg of calcium/day.

Have you booked your annual coeliac blood test? : *

Please call for an appointment.

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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