Dysphagia Assessment Interview & Case History Form

Dysphagia Assessment Interview & Case History Form
Dysphagia Assessment Interview & Case History Form
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For the new Speech-Language Pathologist, student in communication disorders, or the seasoned clinician! Here is a concise, 2-sided, dysphagia interview and case history form. This tool can be used for both inpatient and outpatient clients, for clinical bedside swallowing evaluations or instrumental swallow assessments (MBSS and FEES). This interview and case history form moves through patient complaints, past medical history, symtomatology of all phases of the swallow, respiratory concerns, and their current eating status. Additional writing space is available. This tool is an excellent introduction to your patient and provides vital pieces to the puzzle, to support your diagnosis. The organized layout is sure to streamline your pre-assessment interview!

For the Public: This product is to be used only by professionals adequately trained in the area of communication disorders. If you have any concerns about your speech or language, please see your healthcare professional or speech-language pathologist who can properly assist you.
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Dysphagia Assessment Interview & Case History Form
Dysphagia Assessment Interview & Case History Form