Tonsil Questionnaire
Child's Full Name
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Preferred contact email address (*)
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What are your main current health
concerns about your child?
  
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Does he or she get tonsillitis?
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If YES when was the first episode?
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How many days is he/she miserable for?
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How many episodes of tonsillitis
occurred this year?
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How many episodes of tonsillitis
occurred last year?
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Are there any antibiotics which
your child can not take (due to intolerance or allergy)?
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Does he/she snore?
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Is he/she a restless sleeper?
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Are there pauses in his/her breathing pattern at night?
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Does he/she breathe through the nose or mouth at night?
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Is he/she tired/grumpy/“slow to get going” in the morning?
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Can your child eat food normally?
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Does he/she have smelly breath, even after teeth-cleaning?
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Is he/she tired during the day ?
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How is his/her progress at school?
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Is there a persistently runny nose
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Is there a persistent cough?
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Have you read the tonsil information on my website? (*)
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The captcha is case sensitive - on an ipad it will automatically capatilise the first letter - make sure you turn this off on the keyboard (*) The captcha is case sensitive - on an ipad it will automatically capatilise the first letter - make sure you turn this off on the keyboard
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