Reflux Severity Index (RSI) Hoarseness or a problem with your voice 0 1 2 3 4 5 None Clearing your throat 0 1 2 3 4 5 None Excess throat or mucous post-nasal drip 0 1 2 3 4 5 None Difficulty swallowing food, liquids or pills 0 1 2 3 4 5 None Coughing after you ate or after lying down 0 1 2 3 4 5 None Breathing difficulties or choking episodes 0 1 2 3 4 5 None Troublesome or annoying cough 0 1 2 3 4 5 None Sensations of something sticking in your throat 0 1 2 3 4 5 None Heartburn, chest pain, indigestion, or stomach acid coming up 0 1 2 3 4 5 None First Name Surname DOB Email Phone number Please contact me by email Please contact me by phone Time's up
