Cedar Pollen Symptom Scores
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Rate your symptoms today. Please use the following scale.

Rate your symptoms today. Please use the following scale. 0 - No asthma or allergy symptoms today

1 - Asthma or allergy symptoms present but not causing discomfort

2 - Asthma or allergy symptoms causing discomfort, but not interfering with daily activities or sleep

3 - Asthma or allergy symptoms interfering somewhat with daily activities or sleep

4 - Asthma or allergy symptoms interfering with most activities (and which may have required bed rest, school absence, or telephoning a physician's office)

5 - Asthma or allergy symptoms requiring a physician or emergency clinic visit or hospital admission

When did you experience these symptoms?

	MM		DD		YYYY
Please enter the date	When did you experience these symptoms? Please enter the date Month	/	Day	/	Year

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