GERD-HRQL Questionnaire

If you have heartburn or GERD, or take medications for those conditions, complete the GERD-HRQL (Health Related Quality of Life) questionnaire, print a copy with your answers and consult with a health care provider.

Information gathered from this form is used to understand symptom severity. In accordance with Federal HIPAA regulations, this data will not be linked to an individual’s personal identity.

Velanovich V; The Development of the GERD –HRQL symptom severity instrument; Dis Esophagus. 2007;20(2):130-4



This site is published by EndoGastric Solutions, Inc., which developed it as an information resource to help increase awareness of GERD-related disorders and the available treatment options. This site is not a substitute for medical advice from your physician. The contents of the site are for informational purposes only and are intended to be discussed with your physician. Never disregard any advice given to you by your physician or other qualified health care professional. Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical conditions and treatments.