Updated for 2017!
*** These are ADULT forms in DOCX format. See store for PDF FILLABLE FORMS and for CHILD forms. ***
Description: Due to popular demand, we are offering a collection of ADULT speech therapy forms. These have been adapted from the pediatric forms to include words like “Client” vs. “Child”. Each of the 14 forms has fully customizable information for your own practice. The Header includes an area to insert your logo and contact information, as well as a small table to insert client details (e.g., ID number). The forms match in style to ensure a professional image for your practice.
NOTE: These forms are in DOCX format and are intended for hard-copy use. I personally save the forms in PDF format with Adobe Acrobat Professional and create fillable forms to share with clients.
PDF forms are also available for purchase! To order PDF FILLABLE FORMS, check out the listing:
OR purchase BOTH the child AND adult forms in a discounted package here:
Download the preview file for a FREE FORM!
1. Adult Intake Form: 4 pages; collect detailed information about the client’s background, health, and more.
2. Adult Consent for Release of Information: 1 page; get consent to share and receive information.
3. Contact Log: 2 pages; keep detailed notes regarding every phone call and email for your clients. (identical to child version)
4. Data Collection: 2 pages; the Word version of my free data collection sheet (available as free PDF file in my store). Fully customizable! (identical to child version)
5. Adult Notice of Privacy Practices: 2 pages; inform your clients of standard privacy practices based on the form provided by ASHA in June 2014.
6. Adult Payment Policy: 2 pages; a detailed form explaining insurance terms, forms of payment, and cancellations.
7. Progress Notes: 2 pages; SOAP notes for each session, including Date, CPT code, Duration, and Setting. (identical to child version)
8. Adult Progress Report: 2 pages; a detailed template for reporting your client’s progress in therapy, including an area for client to provide feedback about goals, sessions, and services.
9. Adult Referral to Physician: 1 page; send a professional referral to other healthcare providers.
10. Adult Screening & Evaluation Consent: 1 page; a bulleted description of the differences between screening and evaluation, with areas for concern.
11. Adult Screening Results: 1 page; a concise results page with recommendations for follow up.
12. Session Log: 1 page; a full calendar year. Enter the number of minutes for each date, check off whether session notes were completed, and add invoice numbers and payment status. Current year will be uploaded for free--all buyers will receive an email notice when available for download. (identical to child version)
13. SLP Adult Intake Form: 1 page; this form is intended to be completed by the SLP during referral phone calls or in person. (FREE IN PREVIEW FILE)
14. Adult Treatment Plan & Goals: 2 pages; a detailed template for creating the treatment plan and goals, including areas for diagnoses, evaluation dates, target area / CPT code, long-term and short-term goals, duration, and prognosis. At the end of the form, there is an area to describe the disorder and information about reviewing progress.
Created by Kate Shepard, Ph.D., CCC-SLP
Clinical Director, Speech-Language Pathologist, and Developmental Psychologist at Shadow Me Speech Therapy