Forms:

These forms assist in the diagnosis, treatment, and in assessing degree of burden for various conditions. You may print and complete the relevant forms and bring them to your appointment to assist Dr. Lansford.

How to Make the Most of Your Appointment:

• Child tonsil or adenoid

• Sinus

• Ears (general)

• Adult hearing loss

• Adult tinnitus (noise in ear)

• Ear Infection

• Balance

• Throat

• Thyroid

• Parathyroid

• Oral Cavity (general)

• Oral Tumor (Mass, Lump)

• Mass (Lump, Tumor) in the Head/Neck Area

• Swallowing

• Voice

• Aesthetic (general)

• Aesthetic for Eyes

• Aesthetic for Nose

Assessment Forms:

• Body Dysmorphic Disorder Survey

• Epworth Sleepiness Scale

• Nasal Obstruction Symptom Evaluation: NOSE

• Reflux Symptom Index

• Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS)

• Sinonasal Outcomes Test: SNOT-20

• STOP-BANG questionnaire to identify risk for obstructive sleep apnea in an adult

• Tinnitus Handicap Index

• Voice Handicap Index

Educational Forms

• Meniere’s Disease FAQ

• Nosebleed Epistaxis FAQ

• Reflux: Diet and lifestyle to minimize reflux

• Vocal Hygiene

• TMJ Guidelines