Please download and complete the following forms before your first visit. Most forms are fillable in Adobe Reader or Preview. You may also print, fill by hand, and bring them to your appointment.
If you prefer, completed forms can be emailed in advance to jacquelyn@voicedoctor.net. Filling them out before your visit helps your appointment move along more quickly.
Registration Documents
- Information for Prospective Patients
- Patient Registration – To Fill Out
- History & Physical Form – To Fill Out
- Voice History Form – To Fill Out (our most important form — tells us about your voice troubles)
- Financial Policy – To Fill Out
- Referring Physician Form – To Fill Out
- Notice of Privacy Practices
Directions to Our Office
An interactive map is on our Contact page. You can also open directions directly in Google Maps or Apple Maps.
Botox Documents
If you are scheduled for a Botox injection, please download and complete the questionnaire that applies to your condition.
- Botox Questionnaire – Adductor/Abductor Spasmodic Dysphonia
- Botox Questionnaire – Adductor Spasmodic Dysphonia
- Botox Questionnaire – Abductor Spasmodic Dysphonia
- Botox Questionnaire – Tongue
- Botox Questionnaire – Palate