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2. Do you have any of the following symptoms?
3. Do you have these other symptoms?
4. Do these problems wake you at night?  
5. Are the symptoms associated with eating?  
6. Which foods make it worse?  
7.  Have you seen a physician for this problem?  
8. What options for treatment has your doctor recommended for you?  
9. What type of physician?  
10. Have you used any of these medications?  
11. Which one helped the most?  
12. Currently you use:  
13. Have you had any of the following tests:  
14. Have you had surgery for this condition before?  
15. How did you hear about us?  
16. How else may we help you?  

 

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Advanced Laparoscopic and General Surgery of Norwalk Connecticut
A referral center for patients with severe gastroesophageal reflux disease

Craig L. Floch, M.D. - Neil R. Floch, M.D.

30 Stevens Street, Suite I
Norwalk, CT. 06850
Phone: (203) 852-2600
Fax: (203) 852-2325
E-mail: FlochMD@AOL.com

© Copyright Neil R. Floch, 1999. All Rights Reserved.
Last Updated 8/25/99