Speech-Language Evaluation Template
Identifying Information
Name:
Date of Birth:
Date of Evaluation:
Examiner:
Reason for Referral
Background Information
Assessment Procedures
Behavioral Observations
Speech
Articulation:
Voice:
Fluency:
Language
Receptive Language:
Expressive Language:
Pragmatic Language:
Oral Mechanism Examination
Summary and Impressions
Recommendations