Patient Resources and Questionnaires

The section below includes several surveys. Surveys are an excellent tool for you to assess how much a problem truly affect your day-to-day life. They also help communicate to the physician how severe your quality of life may be affected by the problem. The following surveys assess sleep quality, voice quality, sinuses and allergies issues, and issues with swallowing. If you are affected by any of the above symptoms, we urge you to submit the results of your survey so that we can schedule a consultation with you.

CLICK to DOWNLOAD NEW PATIENT FORMS
Sino-Nasal Outcome Test (SNOT-22) Questionnaire

Sinus Nasal QuestionnaireUncontrolled allergies can cause a variety of symptoms including nasal congestion and progressing to recurrent sinus infections. From headaches to malaise to chronic facial pressure, sinus infections and inflammation can manifest in a variety of ways. The following questionnaire is a good tool to better assess further these issues and how they are affecting your well-being. If you are concerned regarding allergies and sinus issues, please make sure to submit the results of the survey to us so we can help you address them.

Take Our Sino-Nasal Outcome Test (SNOT-22) Questionnaire
Voice Related Quality of Life (V-RQOL) Questionnaire

Voice related Quality of Life IssuesDoes your voice seem to affect your daily activities? Cause you to not be heard or be able to convey your thoughts at your job or at home? Has your voice changed following a recent illness, surgery, trauma, or performance? While many voice changes resolve spontaneously or in a matter of days, some changes require more attention and are best treated earlier to avoid lasting damage. If your voice is not meeting your needs, please take the following the survey to better evaluate the situation. If you are experiencing concerns with your voice, please submit the survey, and we would be happy to review the results and assess your concerns further in a consultation.

Take Our Voice Related Quality of Life (V-RQOL) Questionnaire
Quick EAT-10 Survey – (Eating Assessment Tool)

Eating Assessment Tool - Online FormDo you feel that sometimes food does not easily pass through your throat during meals or that something always seems to be stuck in your throat? Maybe you are even having to clear your throat or cough more? These issues with swallowing affect millions of individuals. Please take the following survey to better assess your swallowing concerns, and if you would like to discuss them further, click submit so we can review the results during a consultation.

Take Our Quick EAT-10 Survey – (Eating Assessment Tool)
Epworth Sleepiness Scale Questionnaire

Epworth Sleepiness Scale QuestionnaireSleep issues affect millions of Americans each year and range from inability to sleep to non-restorative sleep. Many people feel not rested despite sleeping enough hours or deal with snoring and anatomical issues causing airway obstruction when sleeping. The following survey is quick and can provide an insight into the severity of these issues. If you experience poor sleep, we encourage you take the survey and suggest you submit the results so we can schedule a time to meet you and address these concerns.

Take Our Epworth Sleepiness Scale Questionnaire
Insurance Providers We Work With

Aetna PPO/Open Access
Aetna Medicare Complete/AARP
Baylor Scott & White
Beech Street PPO
Blue Cross Blue Shield PPO
Blue Cross Blue Shield Federal
Blue Cross Blue Shield Health Select
(Referral Required)
Care N Care

Cigna PPO
Coventry HealthCare
First Health PPO
Galaxy Health Network
Golden Rule
Great West Healthcare PPO
Humana/Choice Care PPO
Humana Preferred PPO
Humana TRS

Humana Preferred POS-Open Access
Medicare Part B
Multiplan
PHCS PPO/Open Access
Secure Horizon
Texas True Choice PPO
United HealthCare (All Plans)
Well Med