Get Case History Forms For Speech Therapy 2020-2025

Filling out the Case History Forms for speech therapy is an essential step in ensuring that individuals receive the appropriate evaluation and care. This guide provides clear instructions for completing the form online, making the process efficient and user-friendly for all users.

Follow the steps to complete the form accurately and effectively.

1. Use the ‘Get Form’ button to access the Case History Forms for Speech Therapy and open it in your preferred online editor.
2. Begin by entering the name of the individual receiving speech therapy at the top of the form.
3. Input the individual's date of birth to help identify their age group, specifically for infant/early childhood (0-5 years) assessments.
4. Indicate who is completing the form by checking the appropriate box — this could be the patient, spouse, parent/guardian, or another person.
5. Fill in the names of both parents or guardians, followed by the complete address, including telephone and email information.
6. Provide the name and phone number of the pediatrician, along with the name of the individual or agency that referred the user for evaluation.
7. State the reason for evaluation clearly, as this helps speech professionals understand the context of the assessment.
8. Complete the insurance section, including questions about whether a referral is needed and the policy number.
9. List the names and contact information of individuals to whom results should be sent, ensuring complete addresses or fax numbers are provided.
10. Authorize the disclosure of healthcare information by signing and dating the form in the designated section.
11. Fill out the pregnancy history to provide context regarding any complications during pregnancy that could affect speech development.
12. Detail the birth history, including the delivery method and any complications or treatments necessary after delivery.
13. Note the motoric development milestones achieved by the individual and any related challenges.
14. Provide information about the current diet and any issues related to sucking, chewing, or drooling.
15. Fill out the section regarding speech and language development, including any delays and current communication methods.
16. Document any previous therapies the individual has received, including physical, occupational, and speech therapy.
17. Report any significant medical history, ensuring to mention any past or ongoing health concerns.
18. Describe the educational history, including school names, concerns related to attention or communication, and special tutoring requirements.
19. Complete the general behaviors section, noting any behavioral concerns or social interactions.
20. Provide family and social history, particularly regarding any relatives with speech or hearing issues.
21. Finally, make sure to add any important information that may be relevant for the speech pathologist to consider.
22. Once all fields are filled, review for accuracy, then proceed to save changes, download, print, or share the completed form.

Complete your Case History Forms for speech therapy online today for a smooth evaluation process.