SWAL-QOL Hoarseness or a problem with your voice 0 1 2 3 4 5 Clearing your throat 0 1 2 3 4 5 Excess throat or mucous post-nasal drip 0 1 2 3 4 5 Difficulty swallowing food, liquids or pills 0 1 2 3 4 5 Coughing after you ate or after lying down 0 1 2 3 4 5 Breathing difficulties or choking episodes 0 1 2 3 4 5 Sensations of something sticking in your throat 0 1 2 3 4 5 Heartburn, chest pain, indigestion, or stomach acid coming up 0 1 2 3 4 5 Name DOB Email Phone number Please contact me by email Please contact me by phone Time's up
