Tell your story and help others By telling real stories we can reach people who might be sharing your experiences and need our help. Case studies are so important to raise awareness of coeliac disease and the challenges of living gluten free. Telling real stories about real people has real impact and just by sharing your experiences, you could raise awareness of coeliac disease and help someone get diagnosed. If you would like to help, please complete the form and share your story. * = mandatory field Case study personal details First name Surname Date of birth Gender* Female Male Non-binary Prefer not to say Ethnicity Prefer not to say Arab Asian Bangladeshi Asian Chinese Asian Indian Asian Other Asian Pakistani Black African Black Caribbean Black Other Mixed Other Mixed White & Asian Mixed White & Black African Mixed White & Black Caribbean White British White Irish White Other Email address Telephone number Town or city Symptoms and Diagnosis Please briefly share your diagnosis story here: what symptoms did you experience; after your first visit to the doctor how long did it take to receive an official diagnosis; age of diagnosis; current health; how were you diagnosed (endoscopy, blood test) In total, how many people in your household have coeliac disease and what is their relationship to you? How long have you / they been diagnosed? Are you completing this form on behalf of someone else e.g. child/partner/parent? (Please specify) Has your grocery bill for gluten free food increased? If so, by how much? How much do you spend per month on gluten free food? Has the cost of gluten free food affected your ability to maintain a gluten free diet? If you do consume gluten, due to rising costs, how often do you do this? Do you receive any support, financial or food-based, to ensure you have access to gluten free food e.g. prescriptions? Please provide any additional information or comments on your story here: Membership No (if applicable) If your story is selected, are you happy for us to use your story in our marketing materials? – social media, website and press* Social Media Website Press If you are completing this form on behalf of a child or dependent under the age of 18 please provide their details below and ensure you have their permission Include name, date of birth of child and contact details for parent/carer Important information Coeliac UK will use the personal and health information you have given on this form to promote awareness about coeliac disease and gluten related conditions. If we want to pass this information on to the media we will contact you again for permission. The media may wish to publish your story, however this outcome is not guaranteed when you complete the case study form. If they do want to move forward, they may wish to interview you, either in person or over the telephone, and take a photograph to accompany an article. Coeliac UK cannot control how your material gets used by other organisations, or guarantee that it will appear in the way you would like. However, we strive to ensure that it is treated with the utmost dignity and respect and portrayed as accurately as possible. We care about your privacy, so we will keep your data secure and you can rest assured we won’t give any information about you to other organisations not working on our behalf. You can see our full Privacy Policy at www.coeliac.org.uk/privacy-policy. We will contact you after three years to ask if you are still willing for us to use your information in this way. Please tick the box to indicate that you have read the information above:* Yes, I consent to Coeliac UK using the personal, health information I have provided and I give permission for Coeliac UK to use my story and/or image(s) for the purposes described above. No, I do not consent. Verification Click the box Please click the box to indicate you are a human rather than an automated system completing this form. Submit Print page Add to My Favourites