Self-Assessment for GERD
Don't ignore your pain or discomfort. Complete this brief self-assessment to determine if you might benefit from therapeutic intervention.
criteria
| Severity | Score |
| Never | 1 |
| Mild symptoms; not easy to recognize | 2 |
| Significant symptoms; can be endured | 3 |
| Serious symptoms; affect daily life | 4 |
| Very serious symptoms; significantly affects daily functions | 5 |
| Frequency | Score |
| No symptoms in the past one year | 1 |
| Less than once a month | 2 |
| At least once a month | 3 |
| At least once a week | 4 |
| At least once a day | 5 |
Self-Assessment
| Severity (1–5) |
Frequency (1–5) |
|
| Within the past 12 months, have you experienced any of the following symptoms: heartburn, chest burn, chest pain, coughing, voice transformation, hoarseness, uncomfortable feelings radiating from the chest to the throat, constant earache or sinusitis? | ||
| Within the past 12 months, have you ever had gastric acid reflux? | ||
| Within the past 12 months, have you ever had gastric acid reflux coming up to your throat? | ||
| In the past 12 months, how many times did you take antacids or other medicines for stomach ailments? |
If your total score (severity and frequency) is 12 or more, contact the Heartburn and Reflux Center at (775) 356-4980 to schedule a consultation.
The Heartburn and Reflux Center offers innovative treatments that can reduce chronic heartburn, as well as chest or throat discomfort to help you restore your lifestyle.
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