Tonsil Questionnaire Child's Full Name Invalid Input Preferred contact email address(*) Invalid Input What are your main current health concerns about your child? Invalid Input Does he or she get tonsillitis? Yes No Invalid Input If YES when was the first episode? Invalid Input How many days is he/she miserable for? Invalid Input How many episodes of tonsillitis occurred this year? Invalid Input How many episodes of tonsillitis occurred last year? Invalid Input Are there any antibiotics which your child can not take (due to intolerance or allergy)? Yes No Invalid Input Invalid Input Does he/she snore? Yes No Invalid Input Is he/she a restless sleeper? Yes No Invalid Input Are there pauses in his/her breathing pattern at night? Yes No Invalid Input Does he/she breathe through the nose or mouth at night? Nose Mouth Invalid Input Is he/she tired/grumpy/“slow to get going” in the morning? Yes No Invalid Input Can your child eat food normally? Yes No Invalid Input Invalid Input Does he/she have smelly breath, even after teeth-cleaning? Yes No Invalid Input Is he/she tired during the day ? Yes No Invalid Input Invalid Input How is his/her progress at school? Invalid Input Is there a persistently runny nose Yes No Invalid Input Invalid Input Is there a persistent cough? Yes No Invalid Input Invalid Input Have you read the tonsil information on my website?(*) Yes No Click here to read the Tonsil Information Invalid Input I have read and understood your Privacy Statement(*) Yes Click here to read the Privacy Statement Please confirm you have read and understood our Privacy Statement Captcha(*) Refresh Invalid Input Prev
