Help your speech-language pathologists prepare for initial evaluations with a thorough digital intake form. This template gathers client demographics, communication concern type, history of prior therapy, and relevant medical background — for both adult and pediatric patients — so clinicians can begin with context rather than starting from scratch.
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A speech therapy intake form captures the clinical background that shapes an SLP's evaluation approach before the first session. Whether the concern is articulation in a toddler, stuttering in an adolescent, or voice changes in an adult, different presentations require different assessment tools — and knowing in advance which area is primary lets the clinician prepare accordingly.
For pediatric clients, the intake form also establishes the parent or guardian as the primary informant, which is essential for gathering developmental history, birth history, and information about how the communication difficulty affects the child's school and social life. For adult patients, particularly those recovering from stroke or neurological injury, collecting relevant medical history before the evaluation informs both assessment selection and treatment goals.
formformform lets speech therapy practices deploy a professional intake form that clients or parents can complete from home before the first appointment. Submissions are delivered to your inbox immediately, and the form can be embedded on your practice website or sent via a scheduling confirmation link — no paper, no fax, no phone tag.
Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.
Review the starting questions and choices. You can change them in your own copy.
Jane Doe
jane@email.com
(555) 123-4567
Full name of parent or guardian
Describe the specific difficulties you or your child is experiencing, including when they started and how they affect daily life.
Include any diagnoses, hearing evaluations, neurological history, or developmental concerns.
Dr. First Last
Suggested uses, and why this starting point can help. Adapt the questions to your own process.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Date of Birth” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Is this intake for an adult or child patient?” in particular and adapt it to the detail you need.
Give participants a clear set of questions and keep the information together, making it easier to prepare, respond and follow up. Review “Primary Communication Concern” in particular and adapt it to the detail you need.
Gathers stroke or brain injury history, current functional communication abilities, and prior speech therapy for adults with aphasia.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Has the client received speech therapy before?” in particular and adapt it to the detail you need.
Gathers stroke or brain injury history, current functional communication abilities, and prior speech therapy for adults with aphasia.
Click 'Use this template' to open the speech therapy intake form in the formformform editor.
Add domain-specific fields — for example, a section for hearing history, AAC device use, or school/IEP information for pediatric clients.
Adjust required vs. optional fields based on your intake protocol.
Configure email notifications to route completed forms to the assigned SLP before the evaluation session.
Embed the form on your practice website or share the link in scheduling confirmation emails.
Review submissions before each session so the SLP arrives prepared for the specific communication concern.
it keeps responses structured and makes it easier to assign the right evaluations before the session begins.
structured categories tell you the domain, but the narrative tells you the real-life impact and urgency.
parents often minimize past services or forget to mention them, but knowing what has been tried affects goal-setting significantly.
many insurance payers require documentation of a physician referral for speech therapy services.
some adult patients may also have a healthcare proxy or caregiver.
undetected hearing loss is a primary cause of speech and language delays and should be ruled out early.
Collects developmental speech milestones, phonological patterns observed by parents, and previous evaluations for children with speech sound disorders.
Gathers stroke or brain injury history, current functional communication abilities, and prior speech therapy for adults with aphasia.
Asks about fluency history, severity in different speaking situations, emotional impact, and prior fluency therapy experience.
Collects vocal use patterns, occupation, smoking history, reflux symptoms, and prior ENT consultations for patients with voice concerns.
Captures developmental milestones, expressive and receptive language concerns, and bilingual status for children with suspected language delays.
Gathers medical diagnoses, diet texture current tolerance, mealtime observations, and aspiration history for patients with swallowing difficulties.
Collects current AAC use, social communication challenges, behavioral context, and school or therapy support services for autistic clients.
Asks about device availability, internet reliability, caregiver participation, and home practice capacity for remote pediatric speech services.
Gathers professional speaking demands, vocal fatigue patterns, presentation anxiety level, and coaching goals for executive clients.
Documents TBI date, current cognitive concerns like memory and word finding, and return-to-work goals for post-TBI rehabilitation clients.
Collects parent concerns, age-appropriate developmental milestones not yet met, and pediatrician referral details for children under age 3.
Gathers surgical history, resonance concerns, and craniofacial team provider details for children with cleft palate and velopharyngeal dysfunction.
Yes. Add a field asking what device the client will use for sessions (phone, tablet, computer) and whether they have a quiet private space available — both affect the quality of remote sessions.
A radio question at the top asks whether the patient is an adult or a minor. If a minor, a parent/guardian name field appears. You can further customize by adding age-specific sections for developmental milestones or adult medical history.
Yes. Add short_text fields for insurance carrier name, member ID, and group number to capture the details your billing team needs before the first visit.
Yes, with customization. You can add fields for school name, grade level, teacher name, and IEP status to make it appropriate for a school-based intake context.
Every form submission triggers an instant email notification to the address you configure. You can also view and export all submissions from the formformform dashboard.
Gather client background and goals before the first therapy session.
Collect patient info, medical history, and insurance before the appointment.
Take appointment requests with date, time, service type, and reason.
Gather presenting concerns, history, and safety information before first mental health appointments.
Map the daily activities that have become difficult, the home and work environment, and what the person most wants to do again.
Process durable medical equipment requests with prescriber and insurance details.
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