top of page

1-931-455-2005

Use tab to navigate through the menu items.

First Name

Last Name

Email

Do you get treated for several sinus infections each year?

No

Yes (two or less)

Yes (two or more)

Have you tried any other the counter medications?

No

Yes (antihistamines - Allegra, Benadryl, or Claritin)

Yes (decongestants - Mucinex or Sudafed)

Yes (nose sprays - Azalatine, Nasonex, Nasacort, Flonase or Afrin)

I have tried several combinations of the above medications.

How long have you suffered from sinus issues?

One year or longer

Six months

Three months

Six weeks or less

Have you has any of the below testing in the last 6 months?

Allergy testing or Allergy shots

CT of the sinus

Both

Please check all symptoms that apply to you

Nasal Obstruction

Headache

Bad Breath

Facial Pain (cheeks, around eyes, forehead or teeth pain)

Foul drainage from nose

Low grade fever

Snoring

Decrease sense of taste or smell

Ear Pain

Phone

Your answers will be sent to our nursing staff.

A nurse will be in touch with you soon!

Join our mailing list

1821 N. Washington

Tullahoma, TN 37388 | 1-931-455-2005

Hours: Monday - Friday: 8 a.m. - 4:30 p.m.

bottom of page