Speech Language Screening Req & Comprehensive Case History Form: Growing Bundle

This is a growing bundle

This bundle includes our Comprehensive Speech Language Screening Packet (screening information & request form) AND Comprehensive Speech Language Swallowing Hearing Case History Questionnaire

The Screening Packet includes:

• speech & language domains, definitions, and disorders
• speech & language checklist
• speech & language screening request sign-up sheet

It allows speech therapist to educate building staff on:

• speech and language definitions, domains, and disorders to help them be able to identify what area(s) of communication the student demonstrates difficulty in
• checklist for teachers to document areas of concern related to the student
• screening request form/sign-up sheet

The Speech-Language Swallowing and Hearing Case History Questionnaire includes:

• Child's personal information (including cultural, linguistic, ethnic background)
• Family history
• Birth history
• Medical history
• Developmental history (including gross and fine motor development)
• Behavioral characteristics
• Educational history/Academic performance
• Speech-language-hearing development
• Checklist for specific speech, language, swallowing concerns
  • Articulation, receptive language, expressive language, fluency, voice, pragmatic language, play, swallowing, and emergent literacy & phonological awareness

This case history form/questionnaire can be used in various settings including schools and private practice settings. It is intended to be used by speech-language pathologists and can help you identify possible red flags for various diagnoses that could be impacting a child’s speech-language-hearing-swallowing difficulties.

Additionally, this form/questionnaire can serve as a great outline for area of an assessment report and can be expanded to aid you in writing a detailed and comprehensive evaluation report.