Vocal Cord Dysfunction – Questionnaire (VCD-Q)

This questionnaire was developed to help monitor symptoms in clients with a diagnosis of Vocal Cord Dysfunction, or PVFM. These are statements many people have used to describe their breathing symptoms and the effects of these symptoms on their lives. Please select the response that indicates how much you agree with each statement.

1 = Strongly disagree
2 = Disagree
3 = Neither agree or disagree
4 = Agree
5 = Strongly agree

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.