Speech Language Case History Questionnaire for Parents

$$ For the price of a salad, you can have:

A printable, reproducible, comprehensive case history questionnaire for speech language pathologists to send home or to complete with the assistance of a parent/guardian to obtain important information regarding a student's speech and language development and background.

At 3 pages long, this case history questionnaire will provide you detailed information on the student without using up too much ink. It will also be fairly quick and easy for parents/guardians to complete, as it contains check boxes in many sections.

This questionnaire is created with school speech-language pathologists in mind and contains the following major sections:

- Student Information

- Reason for Referral

- Health/Developmental History

- Language Background

- Main Areas of Concern

- Educational History / Academic Performance

The item is unlocked and can be tailored to fit your needs more closely if desired.

It is an excellent foundation for outlining the major areas of an assessment report as well, and can be expanded upon to help you write a highly detailed evaluation.

I hope I have saved you some time and effort in producing a comprehensive, professional intake form to obtain speech-language case history information for each of your students!