Let's get started with some basic information so we can relay your results to you.

By providing my phone number, I agree to receive text message from Boulder Valley ENT.

Do you experience any of the following more than 2 times a year? (click all that apply)

Pressure or pain over the sinuses

Headaches in the front of the head

Sinus congestion

Recurrent sinus infections

None of the Above

Do any of the symptoms you selected last more than 2 weeks at a time?

Yes

No

How do these symptoms affect your life?

(click all that apply)

Decreased activity (work or play)

Difficulty concentrating

Increased frustration

Increased stress

Have you been prescribed medication for a sinus infection or sinus symptoms more than 2 times a year?

Yes

No

Have you been referred to an Ear, Nose and Throat Specialist to evaluate your sinues?

Yes

No

Have you been on more than one type of medication for your sinuses?

Yes

No

Are you tired of trying several different medications for your sinus symptoms?

Yes

No

Not applicable

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