Many of our forms are in PDF format and require you to use Adobe Reader so you can complete them electronically. If you do not have Adobe Reader please follow this link to the free download: http://get.adobe.com/reader/
ENGLISH CLINIC APPLICATIONS:
Child (0-17 years) Speech & Language Assessment Application [pdf] PDF WRITABLE
Adult (18+ years) Speech & Language Assessment Application [pdf]
SPANISH (espanol) CLINIC APPLICATIONS:
Child (0-17 years) Speech & Language Assessment Application [pdf]
Adult (18+ years) Speech & Language Assessment Application [pdf]
New Client Packet [pdf]
Packet includes:
- New Client Letter
- Fee Agreement & Absence Policy
- Fee Schedule
- Documentation Checklist
- Consent for Evaluation and Treatment
- Client Contact Form
- Video Consent and Release Form
- Release of Information Form
- Request for Information Form
- Media Consent Form
- Opt Out Form
FOR STUDENT CLINICIANS:
Chronology Form [pdf]
Communication Tips [pdf]
Confidentiality Agreement [pdf]
Consent and Release Form [pdf]
Extern Supervisor Rating Form [pdf]
Hearing Screening [pdf]
Hearing Evaluation Report [pdf]
Hepatitis B Form [pdf]
LiveScan Fingerprinting Form [pdf]
Observation Hours Form [pdf]
Record of Supervised Clinical Experience [pdf]
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