TEST QUESTIONNAIRES

Anxiety (GAD-7)

Name*
First Last
Date*
Date Format: DD slash MM slash YYYY
Date of Birth*
Clinician*
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious or on edge*
- Not at all
- Several days
- More than half the days
- Nearly every day
Not being able to stop or control worrying*
- Not at all
- Several days
- More than half the days
- Nearly every day
Worrying too much about different things*
- Not at all
- Several days
- More than half the days
- Nearly every day
Trouble relaxing*
- Not at all
- Several days
- More than half the days
- Nearly every day
Being so restless that it is hard to sit still*
- Not at all
- Several days
- More than half the days
- Nearly every day
Becoming easily annoyed or irritable*
- Not at all
- Several days
- More than half the days
- Nearly every day
Feeling afraid as if something awful might happen*
- Not at all
- Several days
- More than half the days
- Nearly every day
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?*
- Not difficult  at all
- Somewhat  difficult
- Very difficult
- Extremely difficult

Paediatric Voice Handicap Index

Name*
First Last
Date*
Date Format: DD slash MM slash YYYY
Date of Birth*
Clinician*
Instructions
These are statements that many people have used to describe their voices and the effects of their voices on their lives. Circle the response that indicated how frequently you have the same experience.
I would rate my/my child’s talkativeness as the following*
- 1 - Quiet listener
- 2
- 3
- 4 - Average talker
- 5
- 6
- 7 - Extremely talkative
My child’s voice makes it difficult for people to hear him/her*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
People have difficulty understanding my child in a noisy room*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
At home, we have difficulty hearing my child when he/she calls through the house*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child tends to avoid communicating because of his/her voice*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child speaks with friends, neighbours, or relatives less often because of his/her voice*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
People ask my child to repeat him/herself when speaking face-to-face*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child’s voice difficulties restrict personal, educational and social activities*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child runs out of air when talking*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
The sound of my child’s voice changes throughout the day*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
People ask, ‘What’s wrong with your child’s voice?’*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child’s voice sounds dry, raspy, and/or hoarse*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
The quality of my child’s voice is unpredictable*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child uses a great deal of effort to speak (e.g. straining)*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child’s voice is worse in the evening*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child’s voice ‘gives out’ when speaking*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child has to yell in order for others to hear him/her*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child appears tense when talking to others because of his or her voice*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
People seem irritated with my child’s voice*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
I find other people don’t understand my child’s voice problem*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child is frustrated with his/her voice problem*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child is less outgoing because of his/her voice problem*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child is annoyed when people ask him/her to repeat*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always
My child is embarrassed when people ask him/her to repeat*
- 0 - Never
- 1 - Almost Never
- 2 - Sometimes
- 3 - Almost always
- 4 - Always

Singing Voice Handicap Index-10 (SVHI-10)

Name*
First Last
Date*
Date Format: DD slash MM slash YYYY
Date of Birth*
Clinician*
Status of therapy*
- Pre-therapy
- Post-therapy
If you are a PERFORMER, please answer each of the following questions, even if your answer is “never” or “no problem”.
SVHI-10: These are statements that many people have used to describe their singing voices and the effects of their singing on their lives. Please indicate how frequently you had the same experience within the past month
It takes a lot of effort to sing*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I am unsure of what will come out when I sing*
- Never
- Almost never
- Sometimes
- Almost always
- Always
My voice “gives out” on me while I am singing*
- Never
- Almost never
- Sometimes
- Almost always
- Always
My singing voice upsets me*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I have no confidence in my singing voice*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I have trouble making my voice do what I want it to do*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I have to “push it” to produce my voice when singing*
- Never
- Almost never
- Sometimes
- Almost always
- Always
My singing voice tires easily*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I feel something is missing in my life because of my inability to sing*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I am unable to use my “high voice”*
- Never
- Almost never
- Sometimes
- Almost always
- Always

Hospital Anxiety and Depression Scale (HADS)

Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Date of birth*
Clinicians*
Tick the box beside the reply that is closest to how you have been feeling in the past week. Don’t take too long over you replies: your immediate is best.
I feel tense or 'wound up':*
- Not at all
- From time to time, occasionally
- A lot of the time
- Most of the time
I still enjoy the things I used to enjoy:*
- Definitely as much
- Not quite so much
- Only a little
- Hardly at all
I get a sort of frightened feeling as if something awful is about to happen:*
- Very definitely and quite badly
- Yes, but not too badly
- A little, but it doesn't worry me
- Not at all
I can laugh and see the funny side of things:*
- As much as I always could
- Not quite so much now
- Definitely not so much now
- Not at all
Worrying thoughts go through my mind:*
- A great deal of the time
- A lot of the time
- From time to time, but not too often
- Only occasionally
I feel cheerful:*
- Not at all
- Not often
- Sometimes
- Most of the time
I can sit at ease and feel relaxed:*
- Definitely
- Usually
- Not Often
- Not at all
I feel as if I am slowed down:*
- Nearly all the time
- Very often
- Sometimes
- Not at all
I get a sort of frightened feeling like 'butterflies' in the stomach:*
- Not at all
- Occasionally
- Quite Often
- Very Often
I have lost interest in my appearance:*
- Definitely
- I don't take as much care as I should
- I may not take quite as much care
- I take just as much care as ever
I feel restless as I have to be on the move:*
- Very much indeed
- Quite a lot
- Not very much
- Not at all
I look forward with enjoyment to things:*
- As much as I ever did
- Rather less than I used to
- Definitely less than I used to
- Hardly at all
I get sudden feelings of panic:*
- Very often indeed
- Quite often
- Not very often
- Not at all
I can enjoy a good book or radio or TV program:*
- Often
- Sometimes
- Not often
- Very seldom

Patient Health Questionnaire (PHQ-9)

Name*
First Last
Date*
Date Format: DD slash MM slash YYYY
Date of birth*
Clinician*
Over the last two weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Feeling down, depressed, or hopeless?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Trouble falling or staying asleep, or sleeping too much?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Feeling tired or having little energy?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Poor appetite or overeating?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Feeling bad about yourself - or that you are a failure or have let yourself or your family down?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Trouble concentrating on things, such as reading the newspaper or watching television?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe
Thoughts that you would be better off dead, or of hurting yourself in some way?*
- None
- Mild
- Moderate
- Moderately Severe
- Severe

Reflux Symptoms Index

Name*
First Last
Date of Birth*
Date*
Date Format: DD slash MM slash YYYY
Within the last month, to what degree did the following problems affect you?
Hoarseness or a problem with your voice*
- 0
- 1
- 2
- 3
- 4
- 5
Clearing of your throat*
- 0
- 1
- 2
- 3
- 4
- 5
Excess throat mucus or postnasal drip*
- 0
- 1
- 2
- 3
- 4
- 5
Difficulty swallowing food, liquids, or pills*
- 0
- 1
- 2
- 3
- 4
- 5
Coughing after you eat or after lying down*
- 0
- 1
- 2
- 3
- 4
- 5
Breathing difficulties or choking episodes*
- 0
- 1
- 2
- 3
- 4
- 5
Troublesome or annoying cough*
- 0
- 1
- 2
- 3
- 4
- 5
Sensation of something sticking in your throat or a lump in your throat*
- 0
- 1
- 2
- 3
- 4
- 5
Heartburn or chest pain*
- 0
- 1
- 2
- 3
- 4
- 5

Voice Handicap Index - 10 Self Rating From

Name*
First Last
Date of Birth*
Date*
Date Format: DD slash MM slash YYYY
Name of Clinician*
Status of Therapy*
- Pre-therapy
- Post-therapy
Instructions
These are statements that many people have used to describe their voices and the effects of their voices on their lives. Tick the response that indicates how frequently you have the same experience.
My voice makes it difficult for people to hear me.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I run out of air when I talk.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
People have difficulty understanding me in a noisy room.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
The sound of my voice varies throughout the day.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
My family has difficulty hearing me when I call them throughout the house.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I use the phone less often than I would like.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
I tend to avoid groups of people because of my voice.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
People seem irritated with my voice.*
- Never
- Almost never
- Sometimes
- Almost always
- Always
People ask, “What’s wrong with your voice ?”*
- Never
- Almost never
- Sometimes
- Almost always
- Always

On this page:

Anxiety (GAD-7)

Over the last 2 weeks, how often have you been bothered by the following problems?

Paediatric Voice Handicap Index

Instructions

Singing Voice Handicap Index-10 (SVHI-10)

If you are a PERFORMER, please answer each of the following questions, even if your answer is “never” or “no problem”.

Hospital Anxiety and Depression Scale (HADS)

Tick the box beside the reply that is closest to how you have been feeling in the past week. Don’t take too long over you replies: your immediate is best.

Patient Health Questionnaire (PHQ-9)

Over the last two weeks, how often have you been bothered by any of the following problems?

Reflux Symptoms Index

Within the last month, to what degree did the following problems affect you?

Voice Handicap Index - 10 Self Rating From

Instructions

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