2017-10-16 My swallowing problem has caused me to lose weight. 0 1 2 3 4 None My swallowing problems interferes with my ability to go out for meals. 0 1 2 3 4 None Swallowing liquids takes extra effort 0 1 2 3 4 None Swallowing solids takes extra effort 0 1 2 3 4 None Swallowing pills takes extra effort. 0 1 2 3 4 None Swallowing is painful 0 1 2 3 None The pleasure of eating is affected by my swallowing. 0 1 2 3 4 None When I swallow food sticks in my throat. 0 1 2 3 4 None I cough when I eat. 0 1 2 3 4 None Swallowing is stressful 0 1 2 3 4 None First Name Surname DOB Email Phone number Please contact me by email Please contact me by phone Time's up
