Private coaching intake

Tell me about your voice.

You’ve handled the payment. Now give me enough context to understand what you’re dealing with. I’ll review this, verify payment, contact you personally and we’ll schedule together.

Contact & Payment

This lets me match your payment and contact you personally after I review your intake.

Name *

Email *

Phone

Time zone *

Coaching option purchased *

Payment method *

Name / username payment came from *

Your Voice & Work

What is your profession or primary line of work?

Does your voice play a significant role in your work? *

How does your voice affect your work or your ability to do your job?

What is your voice currently doing that gives you the most trouble? *

How It Began

When did you first begin noticing symptoms with your voice? *

How did the symptoms first develop? *

Around the time your symptoms first developed, can you recall a significant physical or emotional trauma, major stressor, illness, injury, or other event? *

You do not need to describe the event or go into detail.

Is there anything about the timing that you think would be useful for me to know? (Optional)

Diagnosis & Examination

Have you been formally diagnosed with Spasmodic Dysphonia / Laryngeal Dystonia? *

Have you ever had an ENT examine your vocal cords with a scope? *

Was there anything you were told about the results that you think is important for me to know? (Optional)

Previous Voice Work & Treatment

Have you done any other work, treatments, therapies, exercises, or programs for your voice? *

Please identify what you have tried.

Of the things you've tried, has anything noticeably helped your voice? *

What helped, and what difference did you notice?

Do you currently receive Botox injections for your voice? *

How often do you typically receive them?

Do you feel Botox helps your voice?

Good Days, Bad Days & Physical Sensations

Do you have what you would consider “good days” with your voice? *

What seems to make a good day good?

What seems to make a bad day bad?

Do you experience physical pain associated with speaking or with your throat / voice? *

Where do you feel the pain, and how would you describe it?

At its worst, how severe is the pain on a scale of 1–10?

Do you ever experience the sensation of a lump, pressure, tightness, or something being “stuck” in your throat? *

Briefly describe what that sensation feels like and when you notice it.

What You Want From Coaching

What would you most like to improve about your voice? *

What would a successful coaching experience look like for you?

What days and times generally work best for you to meet?

Is there anything else about your voice, your history, or what you've experienced that you think I should know before we talk?

This intake is sent to Drew by email at drew@spasmodicdysphoniaexercises.com. Please do not include medical records, Social Security numbers, card information, or other sensitive records.

I understand that Drew Hanson is not a physician, speech-language pathologist, or licensed therapist. This coaching is based on Drew’s lived experience with Spasmodic Dysphonia and the voice work he has personally used, and it does not replace diagnosis, medical treatment, or speech therapy.