A speech and language therapy case history form that fits the client in front of you

One preset, two very different conversations

A case history form for speech and language therapy has to serve two clients who share almost nothing. A four-year-old brought in by a parent needs questions about pregnancy and birth, milestones, ear infections and preschool. A sixty-year-old after a stroke needs questions about onset, medical events, and what they can no longer do at work or at home. Most downloadable forms pick one and leave the other practice rewriting. This preset carries both as modes: switch to child and the developmental and guardian sections appear; switch to adult and they give way to onset, medical history and functional impact. Same document, so the two never drift apart — a pediatric speech case history form and an adult one are two modes of the same preset rather than two files to keep in step. Everything is editable and the PDF is there immediately, with no signup and no email wall.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

What a speech language case history form usually captures

In every mode: who is completing the form and their relationship to the client, contact details, the reason for referral in their own words, and who referred them. Then the history that shapes an evaluation — relevant medical background, hearing status and when it was last checked, previous therapy and what it addressed, and current concerns ranked by what bothers the client or family most. The child mode adds pregnancy and birth history, developmental milestones with rough ages, feeding history, education setting and any support already in place. The adult mode adds onset and progression, relevant neurological or medical events, occupation and communication demands, and the daily situations where communication breaks down. Both close with consent and a signature.

Languages and prior services repeat, because they do in real life

Two sections fail constantly on a fixed form. The first is language. A bilingual or multilingual household is common, and a single line asking primary language collects almost nothing useful — what a clinician needs is each language, who speaks it with the client, roughly when it was introduced and how much it is used now. Here that repeats, one row per language. The second is prior services. Clients often arrive having seen several providers across school and clinic settings, and a single box invites a shrug. Here each service repeats too, with the provider, the dates and what it addressed. Neither section takes longer to complete than the fixed version, and both come back genuinely usable rather than nearly empty.

Edit it in plain language, download exactly what you built

Rename the form, rewrite any question or piece of helper text, mark fields required or optional, switch between child and adult modes, and add, duplicate, reorder or remove sections. A school-based caseload and a private adult neuro practice will shape this very differently, and both are minutes of editing rather than a rebuild. A default PDF is ready as soon as the page loads, and after any change a new PDF is generated from your current version, so what downloads matches what is on screen. It prints on US Letter with clean page breaks and room to write more than a word per answer, and reset restores the original preset.

A paediatric caseload, half an hour

An SLP running a mostly paediatric private caseload starts from this preset in child mode. She expands the language section after realising most of her families speak two at home and her old form had one line for it. She adds a question asking what the child most wants to be able to do, alongside the parent's concerns, because the answers often differ and the child's version is the more motivating one. She removes a feeding history section she rarely needs and keeps it as an optional module for when she does. Her supervisor reviews the developmental questions. Half an hour, and the case histories start arriving with the detail she used to spend a first session extracting.

Reported by the family, interpreted by you

Everything here is reported by the client or their guardian and recorded exactly as given. The form does not screen, score, assess, produce oral-motor findings, suggest a diagnosis, decide eligibility for services, or recommend treatment — all of that is the work of a licensed speech-language pathologist with the client in front of them, and a background history is the input to that work rather than a substitute for it. One point worth building into your own wording: a difference between languages is not the same as a disorder, and a history form should collect language background without implying otherwise. Have a licensed SLP review the clinical questions for your caseload, and your practice owner or attorney check the consent and guardian sections, which vary by state and by whether you work in a school setting.