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.


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


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) 352-5384 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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Northern Nevada Medical Center is owned and operated by a subsidiary of Universal Health Services, Inc.(UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.       

Northern Nevada Medical Center

2375 E. Prater Way
Sparks, NV 89434

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Note:The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither Northern Nevada Medical Center, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.          

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