Get Case History Forms Speech Language Therapy

The Case History Forms Speech Language Therapy is a crucial document for understanding an individual's swallowing difficulties. This guide will offer step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to complete your Case History Form online.

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by entering your full name and date of birth in the designated fields to identify yourself.
3. Provide a detailed description of your swallowing problem in the appropriate section.
4. Select the onset of your swallowing issue by checking the relevant box that describes your experience.
5. Indicate whether the problem has changed over time by selecting improved, gotten worse, or remained the same.
6. If applicable, indicate if you have received previous swallowing evaluations or treatments and provide relevant dates and contact information.
7. Describe the consistency of foods and liquids that you currently consume by checking all that apply.
8. Specify if you have a feeding tube and provide additional details about its placement and daily feeding management.
9. Document how you take medication.
10. Report any recent weight loss and provide the number of pounds lost over the specified period.
11. Indicate your appetite level by choosing good, fair, or poor.
12. State any dietary restrictions, if applicable.
13. List any food allergies you may have.
14. Describe any strategies you are currently using to manage your swallowing.
15. Select the length of your meal time by checking the relevant option.
16. Indicate whether you require assistance with meals and describe the nature of that assistance.
17. Note if you wear dentures and specify which type.
18. Describe your current physical status by selecting the appropriate method of mobility.
19. Answer questions regarding your ability to support your upper body and head.
20. Provide a description of your voice quality.
21. Check any additional symptoms that apply to you.
22. If taking medication for reflux, please indicate so and provide details.
23. Write any additional information that may help in understanding your swallowing issues.
24. Review all your responses for accuracy and completeness.
25. You can now save your changes, download the form, print it for necessary records, or share it as required.

Complete your Case History Form online for efficient and effective speech therapy!