Take Our SNOT Questionnaire!Call Us! (901) 861-2526

The following questionnaire is intended to help define your symptoms and provide valuable information and insights for your doctor. Answer the questions, rating to the best of your ability the problems you have experienced over the past two weeks.  After completing the survey, please print this page and bring it to your appointment.

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 ticking the radio button that corresponds with how you feel.

  No
problem
Very mild
problem
Mild or
slight
problem
Moderate
problem
Severe
problem
Problem as
bad as
it can be
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
  No
problem
Very mild
problem
Mild or
slight
problem
Moderate
problem
Severe
problem
Problem as
bad as
it can be
11. Difficulty falling asleep
12. Wake up at night
13. Lack of sleep
14. Wake up tired
15. Fatigue
16. Reduced productivity
17. Reduced concentration
18. Frustrated / restless / irritable
19. Sad
20. Embarrassed
SCORE: 0 out of 100


Score Evaluation Recommended Next Step
0 to 10 No problem to mild problem No actions necessary or symptoms can be treated with OTC medication.
11 to 40 Moderate problem An appointment with a specialist or your PCP is recommended and/or prescription medicine can be taken to treat symptoms.
41 to 69 Moderate to severe An appointment with a specialist or your PCP is recommended and/or prescription medicine can be taken to treat symptoms.
70 to 100 Severe to “as bad as it can be” And appointment with a specialist is recommended, treatment to be determined by doctor. Possible surgical candidate.
*The SNOT score evaluation is to be used as a guide and not a physician’s diagnosis. Treatment to be determined by doctor upon appointment.