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Idade:
Profisso:
Queixa Principal:
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Histria do distrbio:
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Sintomas:
Pigarro:
Dor:
Secura:
Fadiga:
Irritao:
Disfnia:
Hbitos:
Tosse:
Alcool:
Bebe gua:
Fumo:
Outros:
Caf:
Antecedentes cirrgicos:
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Investigao complementar:
Rinite:
Disturbios Bucais:
Disturbios audiolgicos:
Disturbios pulmonares:
Distrbios gstricos:
Outros:
Sinusite:
Realizou tratamentos anteriores? quais?
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O que o paciente acha da sua voz?
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O que os outros acham da sua voz?
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Avaliao:
Corpo durante a fala:
Tenso corporal:
OBS:_________________________________________________________________________________
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Qualidade vocal:
Tipo de voz:
Ressonncia:
Pitch:
Loudeness:
/i/:
/u/:
/s/:
/z/:
Relao s/z:
Estruturas orofuncionais articulatrias:
Lbios:
Lngua:
Bochecha:
Palato duro:
Dentes e ocluso:
Mandibula e ATM:
OBS finais:
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