Documents

Registration documents

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

The following is our patient registration form which will share with us your contact information and allow us to care for you.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may email it back to us at leigha@voicedoctor.net or jody@voicedoctor.net

If it is filled out in advance, your appointment should move along more quickly.

 

The following is our Financial Policy which we ask you to sign that you have read it.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may email it back to us at leigha@voicedoctor.net or jody@voicedoctor.net

If it is filled out in advance, your appointment should move along more quickly.

The following is the referring physician form.  Please note the person having referred you to us.  As well, please add any physician or other provider you might want to learn what went on at your appointment.  If you would like a copy of the visit notes Dr Thomas will prepare, please note that on this form.  We also ask you to make note of any other person you would allow us to talk to about your care, even a family memeber. Otherwise, we woud only talk to you.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may email it back to us at leigha@voicedoctor.net or jody@voicedoctor.net

If it is filled out in advance, your appointment should move along more quickly.

The following is our voice history form, our most important form which tells us about your troubles.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may email it back to us at leigha@voicedoctor.net or jody@voicedoctor.net

If it is filled out in advance, your appointment should move along more quickly.

The following is our Notice of Privacy Practices pamplet - HIPAA.

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

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

Please fill out this form to describe your most recent Botox injection experience (ABductor type).

Please fill out this form to describe your most recent Botox injection experience (ADductor type).

Please fill out this form to describe your most recent Botox injection experience (Palate Myoclonus type).

Please fill out this form to describe your most recent Botox injection experience (Lingual/Tongue Dystonia type).

Surgical Consent Documents

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.

Generic surgical consent form.

This consent form is for Denervation-Reinnervation nerve surgery. 

Laser consent in office procedure.

Travel information

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.

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

The following provides information about lodging, pharmacies, markets, and financial institutions close to the Dr Thomas' office. You can also view all this information on the "Planning your visit" page. Please click the .pdf link to launch the form.