Celiac Disease Questionnaire
What a celiac disease questionnaire asks, with sample questions on symptoms, testing, diet, and family history.
A celiac disease questionnaire records digestive symptoms, past blood tests and biopsies, whether the patient eats gluten now, and family history before a celiac visit. The questions on this page are a typical set built from celiac intake templates and a gastroenterology patient questionnaire.
Celiac disease questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a celiac disease questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample celiac disease questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which digestive symptoms bother you most?Symptoms
- How long have you had these symptoms?Symptoms
- Have you had a celiac blood test?Past testing
- Have you had an endoscopy with a biopsy?Past testing
- Do you eat foods with gluten right now?Diet
- Have you tried a gluten-free diet before?Diet
- Does anyone in your family have celiac disease?Family history
- Have your parents, siblings, or children been tested?Family history
- Which other medical conditions do you have?Medical history
- What surgeries have you had, and when?Medical history
- Which medicines and supplements do you take?Medicines
- Are you allergic to any medicines?Medicines
These are examples to read, not a form to fill in.
Celiac disease questionnaire: FAQ
What does a celiac disease questionnaire ask?
The sample questions on this page are a typical set built from celiac intake and screening templates and a multispecialty clinic's gastroenterology questionnaire. This page groups them into six areas: symptoms, past testing, diet, family history, medical history, and medicines.
Who fills in a celiac disease questionnaire?
The patient, or a parent for a child, before a visit about possible or confirmed celiac disease.
Does it ask about earlier celiac tests?
Yes. One celiac intake template asks whether the patient has had a positive celiac antibody test and a confirming endoscopic biopsy.
Does a celiac disease questionnaire ask about family members?
Yes. Boston Children's Hospital's Celiac Disease Program notes that celiac disease runs in families, so the samples ask which relatives have it.
Is there a template for this form?
The sample questions on this page show a typical set.
What happens after the form is completed?
The gastroenterology team reviews the answers before the visit. AI Doctor collects them; it does not suggest starting or stopping gluten.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
