Complete this Sinus Self-Assessment Quiz and someone from our office can contact you to discuss your responses and next steps.

None

Slight

Mild

Bad

Intense

Severe

1. Facial Pain / Pressure

x

x

x

x

x

x

2. Headache Pain

x

x

x

x

x

x

3. Congestion or Stuffy Nose

x

x

x

x

x

x

4. Nasal Discharge

x

x

x

x

x

x

5. Bad Breath

x

x

x

x

x

x

6. Tooth/Jaw Pain

x

x

x

x

x

x

7. Ear Pain/Fullness

x

x

x

x

x

x

8. Poor Sleep Quality

x

x

x

x

x

x

Click the submit button below to share your Sinus Self-Assessment Quiz results with our office.

Your information will be kept confidential and used only to contact you about scheduling or answering questions. This form is not a substitute for medical care.