Bayside Voice Centre

Call To Discuss Your Vocal Health

Certified Practising Speech Pathologist, Cleveland

(07) 3193 5436

Paediatric Voice Quality of Life Survey (PVRQOL)

Please answer these questions based on what your child’s voice (your own voice if you are a teenage respondent) has been like over the last 2 weeks. Consider how severe the problem is, when you get it and how frequently it happens. Please rate each item below on how bad it is (the amount of each problem).

1 = None, not a problem
2 = A small amount
3 = A moderate amount
4 = A lot
5 = Problem is “as bad as it can be”
6 = Not applicable

The results of these questions will be sent to your Speech Pathologist who will discuss them with you at your next appointment.

 

NB:  Before completing this form, please ensure that you have made an appointment with Jenny Matthews, through Redlands Specialist Centre, (07) 3193 5436. These forms are specifically designed for patients to complete prior to their initial assessment and after you have made an appointment, you will be advised which forms are necessary for you to complete, depending on the reason for your appointment. Because these forms do not collect your contact information, if you complete these forms before making an appointment we will have no way of contacting you to discuss the results.

Because of my child’s voice...

Indicate how much of a problem this is.
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
1 = None, not a problem / 2 = A small amount / 3 = A moderate amount / 4 = A lot / 5 = Problem is "as bad as it can be" / 6 = Not applicable
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Mark E. Boseley, MD; Michael J. Cunningham, MD; Mark S. Volk, MD, DMD; Christopher J. Hartnick, MD, MS Epi (2006). “Validation of the Pediatric Voice-Related Quality-of-Life Survey” Arch Otolaryngol Head Neck Surg. 2006; 132:717-720.