Get Case History Form

Completing the Case History Form online is an important step in ensuring that your child's speech and language evaluation process is efficient and thorough. This guide provides clear instructions to help you accurately fill out each section of the form.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your editor of choice.
2. Begin with the date field and enter the current date. Next, provide your name in the designated area as the person completing the form and specify your relationship to the child.
3. In the 'Description of the problem' section, briefly describe your child's speech and language issues. Follow this by stating the information you hope to gain from the evaluation.
4. Fill out the general information section by entering your child's name, date of birth, address, phone number, and school details as applicable.
5. Provide the names and contact information for the mother and father, including their occupations and phone numbers.
6. In the medical history section, describe the mother’s health during pregnancy and any complications during delivery. List any significant medical conditions your child has experienced.
7. Detail any surgeries your child has had and confirm if they are current on vaccinations.
8. In the developmental history section, indicate the age your child reached significant milestones, such as crawling and walking.
9. Provide information regarding your child's communication style and any difficulties with physical coordination.
10. In the educational history section, describe your child's schooling experience, including any concerns raised by teachers and details about academic performance.
11. Fill out the social history section, noting your child's living situation and their language proficiency.
12. Enter details regarding any previous testing or therapeutic interventions your child has received, including names and contact information for professionals involved in their care.
13. Sign the financial responsibility section, acknowledging your understanding of fees for services rendered.
14. Review all completed sections for accuracy, and when satisfied, you can save changes, download the completed form, print it, or share it.

Complete your Case History Form online today to start the evaluation process for your child.