Share Your Story Survey

The Celiac Disease Foundation loves hearing stories from celiac disease patients, caregivers, and supporters. Sharing your story will help us in our important work of building community and accelerating celiac disease diagnosis, treatments, and a cure.

If you choose to participate, you give the Celiac Disease Foundation permission to reprint your story in whole or in part on its website, social media, and other materials, either with attribution or anonymously. You also have the opportunity to note whether you are willing to be contacted by the Celiac Disease Foundation for a follow-up interview. Your participation is completely voluntary.

We reserve the right to edit content for clarity, length, and appropriateness.

1.First Name(Required.)

2.Last Name(Required.)

3.Email (Required.)

4.Are you sharing your story or the story of your child? (Required.)

Telling my story

Telling my child's story

5.How have you interacted with the Celiac Disease Foundation? Check all that apply. (Required.)

I participated in an event.

I got involved with a clinical study or trial through the Foundation.

I receive email updates.

I follow the Foundation’s social media channels.

I have not been involved before.

6.Share your story, including any details you would like to share about your experience before diagnosis and your life after diagnosis.(Required.)

7.What would a cure mean for you?

8.Can the Celiac Disease Foundation use your name and/or your child's name with your story? (Required.)

Yes, you can use my/my child’s full name

Yes, but use my/my child’s first name only

No, please share my/my child’s story anonymously

9.Can the Celiac Disease Foundation contact you about this story? (Required.)

Yes

10.Do you have a photo that you can share? Attach it below. If you do not attach a photo, we will use a stock photo of something related to your story.

No file chosen

11.By checking the "agree" button below, you indicate that: You have read the above information, you voluntarily agree to participate, and you're at least 18 years of age. (Required.)

Agree