FSSG Scale

1. Do you get heartburn?

A Never

B Occasionally

C Sometimes

D Often

E Always

2. Does your stomach get bloated?

A Never

B Occasionally

C Sometimes

D Often

E Always

3. Does your stomach ever feel heavy after meal?

A Never

B Occasionally

C Sometimes

D Often

E Always

4. Do you sometimes subconsciously rub your chest with your hand?

A Never

B Occasionally

C Sometimes

D Often

E Always

5. Do you ever feel sick after meals?

A Never

B Occasionally

C Sometimes

D Often

E Always

6. Do you get heartburn after meals?

A Never

B Occasionally

C Sometimes

D Often

E Always

7. Do you have an unusual (e.g. burning) sensation in your throat?

A Never

B Occasionally

C Sometimes

D Often

E Always

8. Do you feel full while eating meals?

A Never

B Occasionally

C Sometimes

D Often

E Always

9. Do some things get stuck when you swallow?

A Never

B Occasionally

C Sometimes

D Often

E Always

10. Do you get bitter liquid (acid) coming up into your throat?

A Never

B Occasionally

C Sometimes

D Often

E Always

11. Do you burp a lot?

A Never

B Occasionally

C Sometimes

D Often

E Always

12. Do you get heartburn if you bend over?

A Never

B Occasionally

C Sometimes

D Often

E Always

GERD SCREENING TOOL

**Frequency Scale for the Symptoms of GERD* (FSSG)**

Do you have any of the following symptoms?
If yes, please click the appreciate response below.

GERD SCREENING TOOL

Frequency Scale for the Symptoms of GERD* (FSSG)

Do you have any of the following symptoms? If yes, please click the appreciate response below.

**Frequency Scale for the Symptoms of GERD* (FSSG)**

Do you have any of the following symptoms?
If yes, please click the appreciate response below.