New Patient?

Welcome to Summit. We’re excited to work with you. Below are the new patient forms for you to review and fill out.

Be sure to bring them with you to your appointment. 

See below for our No Show / Late Cancellation Policy

We currently accept the following insurance plans: 

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We accept most insurances including those not pictured above.

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VOICE IMPAIRMENT & UPPER AIRWAY DISORDERS

What is a voice/upper airway disorder?

Symptoms may include:

·      Hoarseness

·      Roughness

·      Breathiness

·      Abnormal pitch

·      Abnormal loudness or volume

·      Loss of voice

·      Weak voice

·      Difficulty projecting voice or Inability to be heard by others

·      Vocal tremor

·      Vocal fatigue

·      Voice that doesn’t match your gender identity

·      Increased vocal effort

·      Running out of breath during speaking

·      Tension in the throat related to speaking

·      Difficulty breathing due to airway closure following a trigger

·      Chronic cough

 

Voice disorders may be caused by:

·      Vocal nodules, polyps, cysts

·      Laryngeal dystonia (Spasmodic Dysphonia) and/or vocal tremor

·      Muscle tension dysphonia

·      Inducible laryngeal obstruction (aka Vocal Cord Dysfunction or Paradoxical Vocal Fold Motion)

·      Aging voice (Presbyphonia)

·      Vocal cord paralysis or paresis

·      Head / Neck cancer and associated treatment

·      Chronic cough

·      Reflux

·      Trauma to the throat or vocal folds

·      Intubation

·      Neurologic conditions such as Parkinson’s disease, stroke


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SWALLOWING IMPAIRMENT

What is Swallowing Impairment (Dysphagia)?

Symptoms may include:

·      Feeling of food “sticking” or caught in the throat

·      Extra effort to swallow

·      Liquids going “down the wrong pipe”

·      Food or liquid remaining in the mouth despite swallowing

·      Food and/or liquid entering the nasal cavity

·      Coughing during or right after eating

·      Difficulty coordinating breathing and swallowing

·      Recurring aspiration pneumonia related to swallowing

·      Avoidance of certain foods or liquids

·      Weight loss or dehydration

·      Pain when swallowing

·      Drooling

Swallowing Impairment may be caused by:

·      Movement disorders such as Parkinson’s disease or ALS

·      Neurologic disorders such as stroke

·      Problems affecting the head or neck, such as cancer, chemoradiation, head/neck surgery, trauma, pulmonary disease or intubation

·      Infectious diseases such as Covid-19, sepsis, acquired immune deficiency syndrome (AIDS)

No Show/Late Cancellation Policy

Please give our office at least 24 hours notice to cancel or reschedule your appointment.

Less than 24 hours notice may result in a late fee of $55.00. A “no-show” is missing a scheduled appointment with no notice. A

“late-cancellation” is canceling/changing an appointment within 24 hours of an appointment. Any charges related to no-show or

cancellations are the responsibility of the patient and will not be billed to insurance.

A charge of $55.00 for each no show

and/or late cancellation appointment

may be assessed.

To cancel or reschedule an appointment, please call Summit Voice and Swallowing at (775) 870-3680. This policy is in effect to

ensure that all of our patients have the opportunity to be seen in a timely manner.