I created this for a specific patient who suffered from myasthenia gravis. This was a way to track her compliance. Since, I have modified this form for patients with functional voice disorders and other swallowing disorders. I have found that this is a great way to keep patients accountable. It also gives them a visual for the work it takes to actually reach goals. I constantly have patients who report difficulty but cannot think of when it happens. This form includes space for logging difficulty swallowing. I have found that it helps identify patterns which helps me in giving appropriate recommendations as therapy progresses. I have uploaded in word document, so feel free to tweak it to fit your needs!