Prior to ENT surgery(-ies) -> The list of symptoms: -> Severity level of symptoms (0 no symptoms, 1 very mild, 2 mild, 3 moderate, 4 severe, 5 extremely – – – – – – severe): + Please attach SNOT-55 (optional, recommended) After ENT surgery(-ies) [prior to ENS treatments (!)] -> The list of symptoms: -> Severity level of symptoms (0 no symptoms, 1 very mild, 2 mild, 3 moderate, 4 severe, 5 extremely – – – – – – severe): + Please attach SNOT-55 (optional, recommended) 2.4. ADDITIONAL CONDITIONS -> Do you suffer from any additional medical conditions (besides ENS): -> If yes, please describe: III ENS TREATMENTS (ENS TTFn) ! Please fill in and attach ENS TREATMENT TESTIMONY FORM for every treatment you had (see ENS-TTFn). IV SUMMARY OF ALL ENS TREATMENTS This section contains a summary of all ENS treatments (described in ENS TREATMENT TESTIMONY FORMs (see SECTION III)) you have had to date and serves as an assessment of your current condition: -> How many ENS treatments have you had in total (up to date)? -> Were your ENS symptoms resolved or do you still need additional treatments? -> Current severity level of ENS symptoms (0 no symptoms, 1 very mild, 2 mild, 3 moderate, 4 severe, 5 – – – – – – extremely severe): -> Level of improvement after all the treatments (0 no improvement, 1 very mild, 2 mild, 3 average, 4 – – – – – significant, 5 very significant): – -> Which symptoms improved: -> Which symptoms did not improve: -> Additional comments (optional): + Please attach SNOT-55 (and any other tests) (optional, recommended) COMMENT: If you had only 1 treatment, this summary applies to this only treatment; if you had 5 treatments, this is a summary of the composite result of all the 5 treatments. V CONSENT I allow my testimony to be published on (for the use of its members): ENSIA’s website [I want my name and contact information to remain confidential: ]
Prior to ENT surgery(-ies) -> The list of symptoms: -> Severity level of symptoms (0 – no symptoms, 1 – very mild, 2 – mild, 3 – moderate, 4 – severe, 5 – extremely severe): + Please attach SNOT-55 (optional, recommended) After ENT surgery(-ies) [prior to ENS treatments (!)] -> The list of symptoms: -> Severity level of symptoms (0 – no symptoms, 1 – very mild, 2 – mild, 3 – moderate, 4 – severe, 5 – extremely severe): + Please attach SNOT-55 (optional, recommended) 2.4. ADDITIONAL CONDITIONS -> Do you suffer from any additional medical conditions (besides ENS): -> If yes, please describe: III ENS TREATMENTS (ENS TTFn) ! Please fill in and attach ENS TREATMENT TESTIMONY FORM for every treatment you had (see ENS-TTFn). IV SUMMARY OF ALL ENS TREATMENTS This section contains a summary of all ENS treatments (described in ENS TREATMENT TESTIMONY FORMs (see SECTION III)) you have had to date and serves as an assessment of your current condition: -> How many ENS treatments have you had in total (up to date)? -> Were your ENS symptoms resolved or do you still need additional treatments? -> Current severity level of ENS symptoms (0 – no symptoms, 1 – very mild, 2 – mild, 3 – moderate, 4 – severe, 5 – extremely severe): -> Level of improvement after all the treatments (0 – no improvement, 1 – very mild, 2 – mild, 3 – average, 4 – significant, 5 – very significant): -> Which symptoms improved: -> Which symptoms did not improve: -> Additional comments (optional): + Please attach SNOT-55 (and any other tests) (optional, recommended) COMMENT: If you had only 1 treatment, this summary applies to this only treatment; if you had 5 treatments, this is a summary of the composite result of all the 5 treatments. V CONSENT I allow my testimony to be published on ENSIA’s website (for the use of its members): [I want my name and contact information to remain confidential: ]