Join Our Healthcare Referral List

Add or Update Your Listing on the NSDA Healthcare Referral List

If you are a healthcare professional that treats people with voice disorders like spasmodic dysphonia, please submit your contact information below to be considered for the on-line NSDA Voice Expert Healthcare Referral List. This form can be used for both new entries and updates to your profile.

PLEASE NOTE: We ask that you only indicate what procedures or services that you personally provide, Please do not include services that other professionals in your clinic provide. For example, if you are a speech pathologist, please do not indicate that you provide botulinum toxin injections; or if you are a laryngologist, please do not indicate that your provide voice therapy. Rather, please share the name(s) of other providers in your clinic in the notes section below and we can follow-up with them directly. This helps to keep the directory accurate.

NSDA Healthcare Directory Form

This submission is a:
This form can be used to both submit a new listing or update your contact information. Please note, name, phone, and email are required. If you are updating your information just update any new information.
- This is a new listing
- Please update my information
Notes (not to be listing on the directory)
Contact Information
Please note we can only list one address. If you practice at multiple sites, please list the main one below and you can include the address of other sites in the box below the address.
Prefix*
Name*
First Last
Suffix*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Practice Name/Institution (required)
Department
Title
Office Phone (for patients for to call)*
Office Fax (if applicable)
Email*

Please note: E-mail addresses are not listed on the website, for internal use only)
Website
Other Locations:
About Your Practice
Medical Specialty
Please check one:
- Laryngologist
- Otolaryngologist
- Speech-Language Pathologist
- Movement Disorder Specialist
Other Medical Speciality:
Treatment Options
NEW: Telemedicine | Telepractice
With the COVID-19 situation, more practitioners are offering virtual appointments through telehealth/telepractice, so we are adding this option to the directory. This is for any medical specialty (Laryngologist, ENT, SLP, etc) offering this service.
- Yes, I am offering Telehealth/Telepractice appointments to patients
Botulinum Toxin Injections
Check all that apply
- Adductor Spasmodic Dysphonia
- Abductor Spasmodic Dysphonia
How many Botox injections do you perform monthly? (if applicable)
Please enter a number from 0 to 200.
Surgical Techniques
Check all that apply
- Selective Laryngeal Adductor Denervation-Reinnervation (SLAD-R)
- Thyroplasty II
- Thyroplasty I
- Myoneurectomy
Other Surgical Techniques:
Rehabilitation Services
Check all that apply
- Voice/Speech Therapy
- Myofascial Release
- Laryngeal Massage
Other Rehabilitation Services:
Additional Treatment Options
Comments
Consent*
I agree to be added to the NSDA Voice Expert Healthcare Referral List
By submitting this form, I agree to have my contact information to be listed on the NSDA website (www.dysphonia.org) and be added to the NSDA mail and e-mail distribution list.
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