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 ⎢