Date: __________________

Dear __________________________________,


___________________________________________________ is a patient of mine who has been diagnosed with celiac disease.

The only known treatment for celiac disease is a gluten‐free diet. The gluten‐free diet is 100% elimination of the protein found in wheat,
rye, and barley from one’s diet.

Please take this into account when reviewing reasonable accommodations for this student.

________________________________________________
Physician Signature

________________________________________________
Physician Contact

National Foundation for Celiac Awareness ⎢P.O. Box 544, Ambler, PA 19002 ⎢ 215‐325‐1306 www.CeliacCentral.org ⎢ info@celiaccentral.org