Reflux Symptom Index - Evaluating Reflux Symptoms

These are statements that many people have used to describe their voices and the effects of their voices on their lives. Please circle the response that indicates how frequently you have the same experience. The Composite of these scores should be 10 or below. If it is more than 10, you should consider an evaluation to check for “Silent Gastroesophageal Reflux Disease, “ or GERD. Within the last MONTH, how did the following problems affect you?

0 = No problem
5 = Severe problem