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DURATION
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When did the symptoms begin?
|
.
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How long did the symptoms last?
|
.
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SYMPTOMS
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Was there pain? Reflux? Both?
|
.
|
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Sore and / or irritated throat?
|
.
|
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Have a persistent dry cough?
|
.
|
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Sour or bitter taste in your mouth?
|
.
|
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Difficult or painful swallowing?
|
.
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What was the most severe symptom?
|
.
|
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IMPACT
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Did the heartburn interfer with sleep?
|
.
|
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Did it interfer with daily activities?
|
.
|
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TRIGGERS
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What did you eat? Drink?
|
.
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Did you eat fast, gulping your food?
|
.
|
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Did you lay down right after eating?
|
.
|
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Taking any non-heartburn meds?
|
.
|
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TREATMENT
|
Taking medication for heartburn?
|
.
|
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Did the medication provide relief?
|
.
|
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How long before relief of symptoms?
|
.
|
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Did your symptoms return?
|
.
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