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Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy

Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy
Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy
Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy
Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy
Child PDF and DOCX forms for Pediatric Private Practice in Speech Therapy
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Compressed Zip File

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5 MB|30 pages
Product Description
Updated for 2017!

*** PDF FILLABLE FORMS *** and editable DOCXs!
*** These are CHILD forms. See store for ADULT forms ***

With this purchase, you will receive both the PDF and DOCX formats of the documents listed below and sold in my DOCX-only listing. The PDFs were created with Adobe Acrobat Professional, so they are fillable forms to share with clients over email. Ideal for the paper-free practice! The PDFs are general in nature and will not be editable by you unless you have an editing program. If you would like them to be customized, such as adding your logo, please purchase the CUSTOM-FOR-ME product listed in my store and I will gladly assist you with your individual needs.

Note: Data Collection & Session Log are too complicated for fillable PDF, so they are in .docx format only.

For lower cost, digital download in DOCX format only is available here:

Description: Ideal for the paper-free practice! This collection of forms arrives in both PDF and DOCX format so you can share with clients via email to complete them electronically! A collection of 16 forms created for use in my private practice. These forms took hours to perfect!

Each DOCX form 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.

Download the preview file for a FREE PDF FILLABLE FORM!

Packet includes:
1. Child Intake Form: 4 pages; collect detailed information about the child’s birth history, health, development, feeding behaviors, and more.
2. 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.
4. Data Collection: 2 pages; the Word version of my free data collection sheet (available as free PDF file in my store). Fully customizable!
5. Free Screening: 1 page; offer free screenings to local schools to boost your referrals.
6. Notice of Privacy Practices: 2 pages; inform your clients of standard privacy practices based on the form provided by ASHA in June 2014.
7. Payment Policy: 2 pages; a detailed form explaining insurance terms, forms of payment, and cancellations.
8. Progress Notes: 2 pages; SOAP notes for each session, including Date, CPT code, Duration, and Setting.
9. Progress Report: 2 pages; a detailed template for reporting your client’s progress in therapy, including an area for parents to provide feedback about goals, sessions, and services.
10. Referral to Physician: 1 page; send a professional referral to other healthcare providers.
11. Screening & Evaluation Consent: 1 page; a bulleted description of the differences between screening and evaluation, with areas for parent to list concerns.
12. Screening Results: 1 page; a concise results page with recommendations for follow up.
13. Session Location: 1 page; do you provide services in more than one location? Parents can provide detailed information (and consent) to visit their children in various settings.
14. 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.
15. SLP 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)
16. 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 in Allen, Texas
Total Pages
30 pages
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Kate Shepard




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