Intake Forms for Speech Therapists: Communication Assessment and Treatment Planning

By Daniel Akselrod · July 2026

A pediatrician’s intake form asks about ear infections. A dentist’s asks about jaw pain. Neither one asks whether a four-year-old can produce the /r/ sound or whether a 68-year-old who had a stroke last month can swallow pureed food without coughing. Speech-language pathology sits at a strange intersection of healthcare, education, and developmental science, and the intake paperwork needs to reflect that. Using a generic medical intake — or worse, borrowing the form from the occupational therapy practice down the hall — means you walk into every evaluation missing half the information you actually need.

The issue is not just completeness. The information you collect at intake shapes the evaluation itself. A child referred for articulation errors needs a different workup than a child referred for language delay, which needs a different workup than an adult referred for voice disorder. Your intake form is how you figure out which evaluation to run before the patient ever sits down in front of you.

Communication disorder screening starts on the intake form

Most SLP intake forms begin with demographics and medical history, which is fine, but then jump straight to “describe your concerns.” That open-ended question is important, but it is not enough. Parents and adult patients describe symptoms, not disorders. A parent will write “he’s hard to understand” without distinguishing between an articulation disorder, a phonological process disorder, childhood apraxia of speech, or dysarthria. An adult will write “my voice is hoarse” without mentioning that they also have difficulty swallowing, which changes the clinical picture entirely.

Your intake form should include a structured communication screening section — not a full assessment, but enough checkboxes and targeted questions to narrow the clinical picture before the appointment. For pediatric patients, this means asking about specific communication behaviors: Does the child combine two or more words? Can unfamiliar listeners understand the child? Does the child follow two-step directions? Does the child use gestures or pointing to communicate? For adults, it means asking about onset and progression: Did the communication difficulty begin suddenly or gradually? Is it getting worse? Is it associated with a medical event like a stroke, surgery, or head injury?

This screening section does not replace the evaluation. It tells you which evaluation to prepare for.

Developmental milestones are not optional for pediatric SLP

In pediatric speech therapy, developmental history is clinical data. When did the child babble? When did they say their first word? When did they start combining words? Were there any periods where they lost skills they previously had? A child who said “mama” and “dada” at 12 months and then stopped talking at 18 months has a fundamentally different clinical presentation than a child who never babbled at all.

Your intake form needs a dedicated developmental milestones section. Not just speech and language milestones — motor milestones matter too. A child who walked late, has difficulty with fine motor tasks, and also has a speech delay may have a broader developmental profile that affects treatment planning. Feeding history belongs here as well. Difficulty transitioning to solid foods, prolonged bottle or pacifier use, and picky eating can all be related to oral motor function, which directly impacts articulation therapy.

Do not bury these questions inside a general medical history section. Clinicians need to see this information at a glance, organized chronologically, before the first session.

Hearing history deserves its own section

This gets overlooked on generic intake forms, and it should not. Hearing loss is the single most common medical cause of speech and language delay in children. A child who has had six ear infections in the past two years may have intermittent conductive hearing loss that is directly causing their speech delay — and if that is the case, the treatment plan looks very different than it would for a child with normal hearing.

Your form should ask about hearing screenings (when was the last one, what were the results), history of ear infections, ear tube placement, family history of hearing loss, and whether anyone in the family has concerns about the patient’s hearing. For adult patients, ask about noise exposure, tinnitus, and whether they use hearing aids. A patient who cannot hear the difference between /s/ and /sh/ is not going to benefit from articulation therapy alone — they need an audiology referral first.

Oral motor function screening

Speech production is a motor act. The tongue, lips, jaw, and soft palate all have to move with precision and coordination for intelligible speech. An intake form that does not ask about oral motor function is missing a fundamental piece of the puzzle.

For pediatric patients, ask about drooling beyond age two, difficulty chewing or swallowing specific food textures, mouth breathing, tongue thrust during swallowing, and history of tongue-tie. For adults, ask about difficulty chewing, food getting stuck, coughing or choking during meals, wet or gurgly voice quality after eating, and any history of oral or facial surgery. These questions flag potential dysphagia, which requires a different evaluation protocol entirely — and which, if missed, carries real safety risks.

IEP, IFSP, and educational documentation

If you work with pediatric patients, a significant portion of your caseload will have existing educational plans. Children who receive school-based speech services through an Individualized Education Program (IEP) or who are in early intervention through an Individualized Family Service Plan (IFSP) already have documented goals, baselines, and progress data. Your intake form needs to capture that.

Ask whether the child currently receives or has previously received speech-language services through school. Ask whether they have an IEP, IFSP, or 504 plan. Ask the parent to bring the most recent evaluation report and progress notes. This is not just helpful context — it affects insurance authorization. Many private insurers will deny outpatient SLP services if the child is already receiving school-based services unless the clinical documentation clearly differentiates the outpatient goals from the school goals. Capturing this at intake lets you address the authorization question before it becomes a denial.

The caregiver interview is intake, not evaluation

In SLP, the caregiver — usually the parent, but sometimes a spouse, adult child, or aide — is a primary source of clinical information. They observe the patient’s communication in natural environments that you will never see. They know which words the child says at home but not at school. They know that their husband can follow conversations one-on-one but gets lost in group settings. They know that their mother chokes on water but not on thickened liquids.

Structure your intake form to capture this information systematically. Include a section where the caregiver rates the patient’s communication abilities across specific domains: understanding spoken language, expressing needs and wants, social communication, reading, writing, and swallowing. Use a simple scale — no difficulty, some difficulty, significant difficulty, unable. This gives you a baseline from the caregiver’s perspective that you can compare against your formal assessment results.

Also ask about the communication environment. How many languages are spoken in the home? Who does the patient communicate with most frequently? Are there communication breakdowns that lead to frustration or behavioral issues? These are not nice-to-know questions — they directly shape the treatment goals. A bilingual child who is “mixing up” languages is not necessarily disordered; they may be code-switching, which is typical bilingual development. But you need the intake form to tell you the child is bilingual in the first place.

Insurance and authorization specifics for SLP

Speech therapy has its own insurance quirks. Many plans limit the number of therapy visits per year, and those limits often apply across all rehabilitation services — meaning SLP, OT, and PT may share a single visit cap. If a child is also receiving occupational therapy, you need to know that at intake so you can plan the authorization strategy accordingly.

Your intake form should ask not just for the insurance information but for the referral source and any prior authorization that has already been obtained. Ask whether the patient has received SLP services in the past 12 months and, if so, through which provider. Ask whether the referring physician has submitted a prescription for therapy — many insurers require a physician order with a specific diagnosis code, and if the referral says “evaluate and treat” without a code, you will need to go back to the physician before submitting the authorization request.

Getting all of this at intake — not after the evaluation, not after the first claim is denied — saves weeks of back-and-forth and keeps the patient in therapy instead of waiting for paperwork to catch up.

Build the form around the clinical workflow

The best SLP intake forms mirror the way clinicians actually think. Demographics and insurance come first because the front desk needs them. Communication screening and developmental history come next because the clinician reviews them before the evaluation. Caregiver observations come after that because they frame the clinical questions. And the educational documentation section comes last because it provides context without driving the evaluation — you need to know what the school has done, but your clinical assessment is independent of their educational assessment.

A speech therapy intake form that follows this structure gives every member of the team — front desk, clinician, billing specialist — the information they need in the order they need it. No hunting through a generic form for the one question about ear tubes. No calling the parent back because nobody asked about the IEP. No authorization denial because the referral source was not documented.

Speech-language pathology is not general medicine, and the intake form should not pretend otherwise. If your practice works with mental health clients as well, many of the same principles apply — the intake needs to reflect the specific clinical questions that drive treatment, not just the demographic boxes that every healthcare practice checks.