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THE ST GEORGE HOSPITAL Sydney Swallow Questionnaire THE UNIVERSITY OF NEW SOUTH WALES DEPARTMENT OF GASTROENTEROLOGY Name: DOB/Sex: Date: This questionnaire is designed to help us establish the severity.

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How to fill out the Sydney Swallow Questionnaire online

The Sydney Swallow Questionnaire is designed to assess the severity of swallowing difficulties. This guide will provide you with comprehensive instructions on how to fill out the questionnaire online, ensuring that you can complete it easily and accurately.

Follow the steps to complete the Sydney Swallow Questionnaire online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your name in the designated field to identify your responses.
  3. Provide your date of birth and sex in the corresponding fields to assist in the assessment.
  4. Answer the first question regarding your overall difficulty swallowing by placing an 'X' on the scale provided.
  5. Continue with the subsequent questions about swallowing different types of liquids and foods by marking 'X' according to your level of difficulty.
  6. For questions about the sensation of food getting stuck or coughing while swallowing, choose the option that best reflects your experience.
  7. Indicate the time it takes you to eat an average meal by ticking one of the provided options.
  8. For the final questions, rate the severity of your swallowing problem and how it interferes with your quality of life.
  9. Once you have completed all sections, review your responses for accuracy.
  10. Save your changes, then download, print, or share the questionnaire as needed.

Complete the Sydney Swallow Questionnaire online today for a better understanding of your swallowing difficulties.

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Background: The Sydney Swallow Questionnaire (SSQ) is a self-report inventory assessing subjective symptoms of oropharyngeal dysphagia with strong content, construct, discriminant, and predictive validity and test-retest reliability in a range of patient populations.

A videofluoroscopy assesses your swallowing ability. It takes place in the X-ray department and provides a moving image of your swallowing in real time. You'll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.

The Sydney Swallow Questionnaire (SSQ) is a 17 question, self-report inventory, which was developed to measure symptomatic severity of oral-pharyngeal dysphagia as reported by the affected patient. The questionnaire uses a 100mm long visual analogue scale (VAS) for all but one question.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232