Get San Francisco Application Form

The San Francisco Application Form for speech, language, and/or hearing services is a vital document used to initiate services at the Communicative Disorders Clinic. This guide provides a clear, step-by-step approach to successfully completing the form online.

Follow the steps to effectively complete the San Francisco Application Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the applicant in the designated field. Ensure that the spelling is accurate as this information is crucial for identification purposes.
3. Provide a contact phone number for the applicant, including home, work, and cell options as applicable. This aids in future communication regarding the services.
4. Fill in the applicant's birthdate to assist in identifying age-related requirements and evaluations.
5. Specify the applicant's address, including city and zip code, to determine geographical eligibility for services.
6. Indicate who is completing the application, which may differ from the applicant.
7. Identify the applicant's primary language and whether they are bilingual. Include information about any languages spoken at home.
8. Provide details regarding the native languages of Parent/Guardian #1 and Parent/Guardian #2 if applicable.
9. Answer whether an interpreter or translator is needed for diagnostic services, and indicate if you can bring your own interpreter.
10. If the applicant is a child, fill out the parent’s name, address, and phone information if it differs from the applicant's details.
11. For adult applicants, provide occupation, employer, and marital status, including spouse's name.
12. Complete the 'referred by' section with the name, address, and title of the referring person or entity.
13. Clearly describe the main concern regarding the applicant, whether it pertains to hearing, speech, language, medical, educational, or social aspects.
14. Document any prior examinations and treatments related to speech, language, hearing, or other special concerns, including associated names and dates.
15. Once all sections are filled out, review the document for accuracy, save your changes, and then download, print, or share the form as needed.

Complete and submit the San Francisco Application Form online to access valuable services.