Evening and Saturday Appointments Available!

Sinus Quiz

Rate each item below based on the severity and frequency of your symptoms.

  • No Problem0
  • Very Mild Problem1
  • Mild or Slight Problem2
  • Moderate Problem3
  • Severe Problem4
  • Problem as bad as it can be5

    Name*:

    Contact no*:

    Email*:

    Total Score:

    1. Need to blow nose

    012345

    2. Sneezing

    012345

    3. Runny Nose

    012345

    4. Nasal Obstruction

    012345

    5. Loss of smell or taste

    012345

    6. Cough

    012345

    7. Post-nasal Discharge

    012345

    8. Thick Nasal Discharge

    012345

    9. Ear Fullness

    012345

    10. Dizziness

    012345

    11. Ear Pain

    012345

    12. Facial Pain/Pressure

    012345

    13. Difficulty falling asleep

    012345

    14. Waking up at night

    012345

    15. Lack of a good night's sleep

    012345

    16. Waking up tired

    012345

    17. Fatigue

    012345

    18. Reduced Productivity

    012345

    19. Reduced Concentration

    012345

    20. Frustrated/Restless/Irritable

    012345

    21. Sadness

    012345

    22. Embarrassed

    012345

    Score Explanation

    • Score
    • Evaluation
    • Recommended Next Step
    • 0 to 10
    • No Problem
    • No actions necessary or symptoms can be treated with
      off-the-counter medication.
    • 11 to 40
    • Moderate Problem
    • An appointment with a specialist is recommended and/or prescription
      medicine can be taken to treat symptoms.
    • 41 to 69
    • Moderate to severe
    • An appointment with a specialist is recommended to determine the
      best treatment options.
    • 70 to 100
    • Severe to “as bad as it can be”
    • An appointment with a specialist is recommended, treatment to be
      determined by doctor. Possible surgical candidate.

    * The evaluation is to be used as a guide and not a physician’s diagnosis.
    Treatment to be determined by a doctor upon appointment.

    Neptune Location Hours

    • Monday: 8am – 7:00pm
    • Tuesday: 8am – 5:00pm
    • Wednesday: 8am – 5:00pm
    • Thursday: 8am – 7:00pm
    • Friday: 8am – 4:30pm
    • Saturday: 8am – 12:30pm

    Allergy Department Hours:

    • Monday 8:30 – 6:15pm
    • Tuesday 8:30 – 4:30 pm
    • Wednesday 9:00 am – 4:00 pm
    • Thursday 8:30 – 6:15pm
    • Friday 9:30 – 1:30pm
    • Saturday 8:00 – 12:00pm

    Coastal Ear, Nose and Throat

    3700 Route 33
    Neptune, NJ 07753

    Tel: (732) 280-7855 (main)

    Fax: (732) 280-7815

    Allergy Department

    3700 Route 33
    Neptune, NJ 07753

    Tel: (732) 280-7855 ext.138

    Fax: (732) 280-7815

    Coastal Surgery Center

    3700 Route 33
    Neptune, NJ 07753

    Tel: (732) 280-5055

    Fax: (732) 361-2056

    • Monday: 6am – 3:00pm
    • Tuesday: 6am – 3:00pm
    • Wednesday: 6am – 3:00pm
    • Thursday: 6am – 3:00pm
    • Friday: 6am – 3:00pm