The offfice staff will inform you of any quesitionnaires that should be completed before your visit.

Patient Pain Questionnaire

In order to make your visit with us more effective we ask that you download and complete the questionnaire below prior to your office visit and bring it with you when you come to your appointment. If you do not complete the questionnaire before your appointment, we ask that you arrive one-half hour before your appointment in order to complete it.

The questionnaire is lengthy and while not all parts may apply to you we do ask that you complete it to the best of your ability. This form will provide the doctor with an overview of your medical, dental, and family history that will assist in assessing all potential factors related to your specific concern.

Also, we ask that you bring any X-rays or other radiographic imaging, pertinent test results, summary reports from previous doctors, and/or dental appliances pertaining to your complaint, which can be helpful for diagnosis.

You can download the Patient Pain Questionnaire as a word document or a pdf (requires adobe reader). Enter your data online or manually then bring the form with you to the office.

The Vanderbilt Head and Neck Cancer Symptom Survey

Please see links below to download.

You can download the Head and Neck Cancer Symptom Survey as a word document or a pdf (requires adobe reader).

Oral Health Assessment – Late Oral Complications Appendix VHNSS

Please see links below to download.

You can download the Oral Health Assessment as a word document or a pdf (requires adobe reader).

Oral Addendum to EORTC

Please see links below to download

You can download the Oral Addendum to EORTC as a word document or a pdf (requires adobe reader).

Referral Form

Please see links below to download

You can download the referral form as a word document or a pdf (requires adobe reader).

Oral Lesion

Please see links below to download

You can download the Oral Lesion as a word or a pdf (requires adobe reader).