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VASAP Self-TestYes      No

1. Do you have symptoms such as itchy watery eyes, runny nose, nasal congestion or difficulty breathing?

      

2. Do any of these symptoms occur when being around dogs, cats, seasonal allergens or mold?

      

3. If yes to the above, do these symptoms bother you more than once per week?

      

4. Have you ever had shortness of breath that was unexplained?

      

5. Have you had wheezing?

      

6. Do you feel the need to clear your throat more than once per week?

      

7. Do you have a cough that never seems to go away?

      

8. Have you ever had unexplained skin rashes?

      

9. Do you think you get nasal, sinus or bronchial infections more than you should?

      

10. Have you had difficulty sleeping at night due to breathing, stuffy nose or snoring?

      




Copyright 2005, Vanderbilt Asthma Sinus Allergy Program