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GERD Self-Assessment
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GERD Self-Assessment
Learn if You May Have GERD
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 and throat, constant earache or sinusitis?
Severity
Never
Mild
Significant
Serious
Very serious
Frequency
No symptoms
Less than once a month
Once a month
Once a week
Once a day
Within the past 12 months, have you ever had gastric acid reflux?
Severity
Never
Mild
Significant
Serious
Very serious
Frequency
No symptoms
Less than once a month
Once a month
Once a week
Once a day
Within the past 12 months, have you ever had gastric acid reflux coming up to your throat?
Severity
Never
Mild
Significant
Serious
Very serious
Frequency
No symptoms
Less than once a month
Once a month
Once a week
Once a day
In the past 12 months, how many times did you take antacids or other medicines for stomach ailments?
Severity
Never
Mild
Significant
Serious
Very serious
Frequency
No symptoms
Less than once a month
Once a month
Once a week
Once a day
You have not filled in all of the assessment answers. Please fill in all of the questions and resubmit!
Contact the Comprehensive Reflux Center at 775-352-5384 to schedule a consultation. The earlier you address your symptoms, the better your outcome will be. You can also fill out the form below to have a representative contact you.
You may not have GERD. For more information contact the Comprehensive Reflux Center at 775-352-5384.
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