SNOT 22

This questionnaire is designed to help determine your symptoms and provide your doctor with valuable information about your sinus disease. Please answer the questions, rating to the best of your ability the problems you have experienced over the past two weeks. Consider how severe the problem is when you experience it and how frequently it happens, please rate each question on how "bad" it is by selecting the number that corresponds with how you feel.
*The higher you score means your sinus problems are more severe

Question Title

* 1. First and Last name:

Question Title

* 2. Please provide us with your email address to allow provider to contact you to discuss whether you're a candidate or not.

Question Title

* 3. Phone number:

Question Title

* 7. How did you hear about us?

For the following questions, please answer based on how your symptoms have been, if it is not a problem for you, select "no problem".  Your score will be based on how severe each problem is that you are experiencing. The more severe results in a higher score.

Question Title

* 8. Need to blow nose

Question Title

* 9. Cough

Question Title

* 10. Sneezing

Question Title

* 11. Runny nose

Question Title

* 12. Post nasal discharge

Question Title

* 13. Thick nasal discharge

Question Title

* 14. Ear fullness

Question Title

* 15. Ear pain

Question Title

* 16. Dizziness

Question Title

* 17. Facial pain/Pressure

Question Title

* 18. Difficulty falling asleep

Question Title

* 19. Lack of sleep

Question Title

* 20. Wake up at night

Question Title

* 21. Wake up tired

Question Title

* 22. Fatigue

Question Title

* 23. Reduced productivity

Question Title

* 24. Reduced concentration

Question Title

* 25. Frustrated/Restless/Irritable

Question Title

* 26. Sad

Question Title

* 27. Embarrassed

Question Title

* 28. Sense of taste/smell

Question Title

* 29. Blockage/Congestion of nose

T