Velopharyngeal dysfunction (VPD) is a complex resonance disorder that can result from structural defects, neuromuscular conditions, or mislearning. In this chapter, the importance of the clinical assessment of patients with VPD will be discussed, with particular emphasis on the history and physical exam. Upon completion, the reader should be able to describe various etiologies of VPD, relevant history and physical exam findings, and important medical considerations in preparing patients for VPD surgery. The initial clinical assessment lays the foundation for accurate diagnosis and treatment of velopharyngeal dysfunction. Collaboration among an interdisciplinary team of providers is crucial to delivering the best care for these patients.