Voice Clinic

Help a child. Donate.

First appointment

Book your first appointment

"*" indicates required fields

Name of doctor who referred you

Department you are being referred to (if known)

Attach a referral*

Accepted file types: jpg, png, pdf, doc, jpeg, Max. file size: 2 MB.

Please make sure that your attachment is clear and legible. We do not process incomplete applications or provide appointments without a copy of the referral. If you do not attach your referral, you will need to fax it to the department directly. Wait times depend on the priority assigned to the referral and can be as long as several months.

Patient Information

Child's last name*

Child's first name*

Date of birth*

MCH Medical record number (if known)

Health insurance card number*

Health insurance card expiration date*

'DD' corresponds to the child's date of birth.

Address*

Select your province or territory*

City*

Postal code*

Contact Information (for parent or guardian)

Your first name*

Your last name*

Your relationship to patient*

Email address

Phone number*

Alternate phone number

Diagnosis

Confirmed diagnosis

Please note details.

Post-traumatic

Please note trauma mechanism.

Please confirm:*

The child is able to cooperate and phonate/ follow instructions while having a scope through the nose.

History of the voice problem

When did the symptoms start?*

Symptoms appeared...*

suddenly

gradually

Describe the child’s voice (e.g. hoarse, weak, etc.).*

Medical history

Has the child had an assisted birth (e.g. forceps, ventouse, clavicle fracture)?*

If you answer YES please specify.

Was the child ever intubated?*

If you answer YES please specify number of weeks.

Has the child had multiple intubations?*

If you answer YES please specify how many.

Has the child had airway surgery?*

If you answer YES please specify.

Feeding problems (e.g. dysphagia, swallowing problems, choking, etc.)*

If you answer YES please specify.

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Voice Clinic

Services
Team
Resources

We are a team of passionate professionals offering evaluation and treatment of complex voice problems and voice disorders in children and adolescents. Voice problems can have significant impacts on a child’s socialization, performance in school and sports, and self-esteem. Our expert team consists of pediatric otolaryngologists and voice therapists dedicated to helping children reach their potential.