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Reflux Severity Index (RSI )

How to complete this Questionnaire:

  • These are statements many people have used to describe their voices and the effects of their voices on their lives
  • In the last 1 month, how did the following problems affect you?
  • Select the rating number that reflects the severity of the problem for you, for each statement.
0 - 5 Rating Scale
0 = no problem
1 = Very mild problem
2 = Moderate or slight problem
3 = Moderate problem
4 = Severe problem
5 = Problem as bad as it can be
Hoarseness or a problem with your voice

Clearing your throat

Excess throat or mucous post-nasal drip

Difficulty swallowing food, liquids or pills

Coughing after you ate or after lying down

Breathing difficulties or choking episodes

Troublesome or annoying cough

Sensations of something sticking in your throat

Heartburn, chest pain, indigestion, or stomach acid coming up

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  • Address Level 1, 449 Swan Street Richmond VIC 3121
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