NOSE

Please help us to better understand the impact of nasal obstruction on your quality of life by completing the following survey. Over the past ONE month, how much of a problem were the following conditions for you? Please select the most correct response for each category.

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* 1. Name:

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* 2. Please provide us with your email address so our providers can contact you if you are a candidate:

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* 3. Phone number:

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.

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* 7. Nasal congestion or stuffiness

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* 8. Nasal blockage or obstruction

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* 9. Trouble breathing through my nose

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* 10. Trouble sleeping

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* 11. Unable to get enough air through my nose during exercise or exertion

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