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Smell-Qx — Pre-SGB Olfactory & Gustatory Assessment

This 10-minute survey helps your care team evaluate your sense of smell and taste before your Stellate Ganglion Block (SGB). Your answers become part of your medical record. Please answer honestly; some questions appear only if relevant.

Consent

I agree — I understand the purpose of this assessment and consent to provide this information for my medical record.

I agree — I understand the purpose of this assessment and consent to provide this information for my medical record.