Online Sinus Questionnaire

Below you will find a list of symptoms and social/emotional consequences typically associated with sinus issues.  There are no right or wrong answers, so make sure to provide the most honest answers for yourself. Please rate your problems, as they have been over the past two weeks.

Thank you for taking the time to visit and please contact us at 845-360-9197 with any questions you may have.

Considering how severe the problem is when you experience it and how frequently it happens, please rate each item below on how ‘bad’ it is by selecting the number that corresponds with how you feel using this scale:

1. Need to blow nose


2. Sneezing


3. Runny nose


4. Cough


5. Post nasal discharge


6. Thick nasal discharge


7. Ear fullness


8. Dizziness


9. Ear pain


10. Facial pain/pressure


11. Difficulty falling asleep


12. Wake up at night


13. Lack of a good night’s sleep


14. Wake up tired


15. Fatigue


16. Reduced productivity


17. Reduced concentration


18. Frustrated/restless/irritable


19. Sad


20. Embarrassed