Voice Supplement

How long have you had a problem with your voice? ___________________

Did the problem come on slowly or suddenly? _______________________

Have you been examined by an Ear, Nose and Throat specialist regarding
your voice problem? _____ If yes, what was said about the nature of your
voice problem? ___________________________________________
_________________________________________________________

Is your voice BETTER or WORSE at certain times of day? _________ If

so, please describe when it is better and when it is worse. _____________
_________________________________________________________
_________________________________________________________

Do you smoke tobacco or consume alcohol? _______ If yes, please describe

how often you use either of these, and about how much of each you consume
per day or week? ____________________________________________

About how much do you use your voice each day? ____________________

Do you have to use your voice in noisy conditions? ______

If yes, please describe the situations and how often they occur?
_________________________________________________________
_________________________________________________________

Do you tend to speak loudly from where you are, or go to another person so
that you do not have to talk loudly? ______________________________
_________________________________________________________

Do you like your voice the way it is? ______ In either case, please explain
why? _____________________________________________________
_________________________________________________________
Do you think that other people like your voice the way it is? ______
In either case, please explain. __________________________________
_________________________________________________________
_________________________________________________________

Has your voice been evaluated before? ______ If yes, what were the
results? __________________________________________________
_________________________________________________________
_________________________________________________________

Have you had voice therapy before? ____If yes, what were the results?
_________________________________________________________
_________________________________________________________

Is there anything else that you feel we should know that would help us
understand your voice use and voice problem better? ____If yes, please
explain. ___________________________________________________
_________________________________________________________
_________________________________________________________
____________________________________________________________