Pre-Operation Check List

I. List all previous/current medical history including diseases or any of health issues you
have been/are diagnosed with. (ex. diabetes, high blood pressure, hepatitis, tuberculosis,
thyroid gland, stroke, high liver level etc.) Please be very specific even if it is a small issue.
Diagnosed with acne when I was 13. Treated with accutane

II. Are you allergic to any medication/food?

No

III. List all the medications you are taking (Ex. Aspirin, Tylenol, hormone injection/pill,
birth control pill, vitamin, sleeping pill, anti-depressant, dietary supplement, etc.)
*Hormone injection/pills and Aspirin should be stopped 14 days before your operation.
100mg spironolactone 2x daily, 2mg estradiol 2x daily, 2mg medroxyprogesterone 1x daily,
2000mg biotin 2x daily.
IV. List all accident experience or surgeries you have received in your entire life. Put dates
beside please. (E.g.Voice Feminization Surgery, Sex Reassignment Surgery, thyroid
cartilage reduction, Jaw reduction, etc. Be specific please.)
*2 month term is required between VFS surgery and other surgeries under general
anesthesia.
None

V. Describe if youve had any problems under general anesthesia. (Ex. recovering
consciousness during anesthesia, difficult breathing, vomiting, nausea, etc.)
None

VI. Describe for any weak teeth (front), dental implant (front), bridges and etc.
None

VII. Please let us know if you have had any issues according to your blood test, EKG, or Xray before (abnormal levels, etc)/ Also please inform if you have any voice problems (e.g.
lowered pitch after trachea shave, weak and hoarse voice, severe vocal tremor etc.)
None, aside from a weak falsetto due to a bad voice teacher when I was younger + poor singing
technique. My mixed voice register has gotten stronger recently.
After voice surgery, we do not take responsibility of any incident occurring from the
medical information not given here so please be responsible to provide all the details in
this form.

*Important: Please note that any patients with AIDS, HIV, renal failure, high liver level, liver
cirrhosis and cold symptoms (fever and cough especially) are not able to have operations at
Yeson Voice Center.

Patient Information (Please use Passport information)

Name on your passport: Julian Scherer

Date of birth (e.g. Jan 1st, 1999): 11/01/1994
Gender (shown in the passport): Male
Nationality: USA
Contact number: (386) 898-1732
E-mail: jscherer2@hotmail.com
Home address: 810 Lakeland Drive
Height (Cm): 171.5cm
Weight (Kg): 65.8kg
Voice file:
*VFS surgery can increase ones vocal fundamental frequency about 74hz in average
so if your fo is below 120Hz, your pitch may not get fully feminized or you will need to see
the speech therapist to more effectively train your female resonance.
***[Important] To check your surgical eligibility, please send your voice file according to
the instruction below.***
1. Make 'Ah' sound for 10 seconds at your comfortable pitch
2. Repeat no.1
3. Read rainbow passage
4. Self-introduction or free talking for 15~20 seconds

The Rainbow Passage

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a
division of white light into many beautiful colors. These take the shape of a long round arch, with its path
high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot
of gold at one end. People look, but no one ever finds it.

Important notice: If you had/are planning other surgeries under general anesthesia, you
should have at least two month term between Voice Feminization Surgery and other types of
surgeries.

Cancellation policy: 6 week-cancellation-notice prior to your scheduled appointment is

required. If not rescheduling will be strictly restricted for 2 years.