Consider 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 button that corresponds with how you feel.
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Need to blow nose
Sneezing
Runny nose
Cough
Post-nasal discharge
Thick nasal discharge
Ear fullness
Dizziness
Ear pain
Facial pain / pressure
Difficulty falling asleep
Wake up at night
Lack of sleep
Wake up tired
Fatigue
Reduced productivity
Reduced concentration
Frustrated / restless / irritable
Sad
Embarrassed
Problem as bad as it can be
Severe Problem
Moderate Problem
Mild or Slight Problem
Very Mild Problem
No Problem
Severe Problem
Moderate Problem
Mild or Slight Problem
Very Mild Problem
No Problem
You received a score of 0
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