Documents

Registration documents

The following is our new patient packet including all registration forms. It is form-fillable. Please click the .pdf link to download it.

The following is the Information for prospective patients. Please click the .pdf link to launch the form.

The following is our patient registration form. It is Form-fillable. Please click the .pdf link to launch the form.

The following is our Financial Policy. Please click the .pdf link to launch the form.

The following is the referring physician form. It is Form-fillable. Please click the .pdf link to launch the form.

The following is our voice history form. It is Form-fillable. Please click the .pdf link to launch the form.

We are located in Portland, Oregon. Check out the Google map or click the .pdf link to launch the document, which also contains directions.

Botox Documents

This consent form pertains to Botox injections.

Fill out this form to rate your Botox injection experience (ABductor type).

Fill out this form to rate your Botox injection experience (ADductor type).

Fill out this form to rate your Botox injection experience (Palate Myoclonus type).

Fill out this form to rate your Botox injection experience (Lingual Dystonia type).

Fill out this form to rate your Botox injection experience (mixed AD/ABductor type).

Travel information

This is a listing of area hotels, listed by proximity to our office. You can also view all this information on the "Planning your visit" page. Please click the .pdf link to launch the form.

If you are coming to our office from out-of-town for a surgical procedure, please review this brief information sheet.

This 2-page file provides a map and directions between our office and Portland International Airport (PDX).

We are located in Portland, Oregon. Click here for the google map, or print out our 2-page driving map below. Please click the .pdf link to launch the form.

The following is the area information map. It contains information about area lodging, pharmacies, markets, and financial institutions. You can also view all this information on the "Planning your visit" page. Please click the .pdf link to launch the form.

Surgical Consent Documents

This consent form is for generic use.

This consent form is for Denervation-Reinnervation surgeries. This specifically applies to the recurrent laryngeal nerve. A portion or all of the recurrent laryngeal nerve is cut and in other nerve in the neck is donated. Typically the nerve called the ansa cervicalis going to the omoyhoid muscle is cut and donated. It iss sutured to the recurrent laryngeal nerve stump and will grow into the muscles of the larynx. When it goes in, it may provide some motion and some additional strength and bulk of the muscles within the larynx.

This procedure is also used for laryngeal spasms and laryngeal dystonia. The new nerve tends to eliminate the spasms.

This consent form is for KTP laser procedures.

This consent form is for Radiesse injections.

This consent form is for Collagen injections.

This consent form is for Feminization Laryngoplasty surgeries.

This consent form is for Microlaryngoscopy surgeries.

This consent form is for Medialization Laryngoplasty surgeries.

Registration Documents - Feminization Laryngoplasty

The following is our new patient packet {for FemLar patients ONLY} including all registration forms. It is form-fillable. Please click the .pdf link to download it.

The following is our voice history form. Please click the .pdf link to launch the form.

The following is information for prospective FemLar patients. Please click the .pdf link to launch the form.

We are located in Portland, Oregon. Check out the Google map or click the .pdf link to launch the document, which also contains directions.

The following is our FemLar patient registration form. It is Form-fillable. Please click the .pdf link to launch the form.

The following is our Financial Policy. Please click the .pdf link to launch the form.

The following is the referring physician form. It is Form-fillable. Please click the .pdf link to launch the form.