Sinus Questionnaire

Sinus Questionnaire

In order to treat our patients successfully, an accurate diagnosis needs to be made first.
This Sinus Questionnaire is intended to measure your symptoms along with the frequency and duration they occur. This quiz is simply a tool and can assist with a full diagnosis.

Please put a checkmark in the box to the symptom you are experiencing.

 Facial Pressure/Pain Headache Pain Congestion or Stuffy Nose Thick, Yellow-Green Nasal Discharge Postnasal Drainage Bad Breath Pain In The Upper Teeth

Frequency and Duration Assessment

Please put a checkmark in the box next to the statements which apply to you.

* First Name :
* Last Name :
* E-mail :
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