Celiac Disease Risk Assessment Form

Celiac Disease Risk Assessment: Identify Symptoms Before Your Visit

Celiac disease affects approximately 1 in 100 people worldwide, yet many cases remain undiagnosed for years. This Celiac Disease Risk Assessment Form helps healthcare providers streamline patient evaluations by collecting critical symptom information, malabsorption indicators, and family history details before the appointment—saving time and enabling more informed consultations.

Why Pre-Visit Symptom Assessment Matters

For gastroenterology practices, primary care physicians, and dietitians, gathering detailed symptom histories can be time-consuming during appointments. This assessment form allows patients to thoughtfully document their gastrointestinal symptoms, nutritional concerns, and family medical history from home, giving healthcare providers a comprehensive overview before the visit even begins.

By identifying key risk factors—including chronic diarrhea, unexplained weight loss, iron-deficiency anemia, and first-degree relatives with celiac disease—this form helps clinicians prioritize testing and develop targeted diagnostic plans more efficiently.

Paperform: The Perfect Solution for Healthcare Symptom Assessment

Paperform makes it simple for healthcare practices to create professional, HIPAA-alternative compliant symptom assessments that patients can complete on any device. With its document-style editor, you can customize this celiac disease risk assessment to match your practice's branding while maintaining a clean, accessible patient experience.

The form uses conditional logic to reveal follow-up questions based on symptom responses, reducing unnecessary clutter and creating a more personalized assessment journey. For example, if a patient indicates digestive symptoms, they'll see detailed questions about frequency and severity—while those without symptoms skip ahead seamlessly.

Streamlined Workflows for Gastroenterology and Primary Care

This template is ideal for:

• Gastroenterologists and GI specialists conducting celiac disease screenings
• Primary care physicians evaluating patients with unexplained digestive complaints
• Registered dietitians assessing nutritional deficiencies and malabsorption
• Pediatricians screening children with growth delays or chronic abdominal pain
• Telehealth providers gathering comprehensive histories for virtual consultations

Automate Patient Intake with Stepper

Connect this form to Stepper to automatically route high-risk assessments to clinical staff, trigger appointment scheduling workflows, or update electronic health record systems. When a patient indicates multiple risk factors, Stepper can instantly notify your care team and initiate appropriate follow-up protocols—ensuring no concerning symptoms fall through the cracks.

Key Features for Healthcare Providers

• Comprehensive symptom tracking covering gastrointestinal, dermatological, and systemic manifestations
• Malabsorption indicator questions including weight changes, vitamin deficiencies, and bone health
• Detailed family history section to identify genetic predisposition
• Mobile-friendly design so patients can complete assessments from their phones
• Conditional logic that adapts questions based on previous answers
• Secure data collection with SOC 2 Type II compliance and encryption

Professional, Patient-Friendly Design

Unlike generic survey tools, Paperform allows you to create assessments that look and feel like part of your practice's website. Add your logo, adjust colors to match your brand, and include educational content about celiac disease alongside assessment questions. The result is a professional tool that builds patient confidence and increases completion rates.

Whether you're screening hundreds of patients monthly or conducting targeted evaluations for high-risk individuals, this template provides the clinical detail you need in a format that's easy for patients to complete and for your team to review.

Start using Paperform's Celiac Disease Risk Assessment Form today to improve diagnostic efficiency, enhance patient care, and streamline your pre-visit workflows—all without writing a single line of code.