Get the free Speech and Language Referral Form

This document is used to collect information regarding a student's speech and language concerns for assessment purposes within the Algonquin and Lakeshore Catholic District School Board.

How to fill out speech and language referral

How to fill out Speech and Language Referral Form

1. Start by downloading the Speech and Language Referral Form from the appropriate website or obtaining a physical copy from the relevant authority.
2. Fill in the personal details of the individual requiring assessment, including their full name, date of birth, and contact information.
3. Provide information about the individual's current educational setting, including school name and contact details.
4. Describe the specific concerns regarding the individual's speech and language development in detail.
5. Include any relevant medical history or diagnoses that may affect speech and language.
6. Attach any supporting documentation or reports from teachers, therapists, or medical professionals if available.
7. Review the form to ensure all information is accurate and complete.
8. Submit the completed form according to the provided instructions, either electronically or by mail.

Who needs Speech and Language Referral Form?

1. The Speech and Language Referral Form is needed by parents or guardians of children who have concerns about their speech and language development.
2. Teachers or educators who observe difficulties in communication skills in their students may also require this form to initiate referrals.
3. Healthcare professionals who identify speech and language issues during assessments may use the form for referrals as well.

People Also Ask about

What are the referral criteria for speech and language therapy?

Refer to speech and language therapy if… The child finds it difficult to learn and understand words. The child finds long and complicated instructions hard to understand. The child is only using short, simple phrases with limited vocabulary.

How to write a speech referral?

However, SLPs need only nine pieces of information to get the ball rolling: name, date of birth, grade, teacher, vision and hearing status, parent concern and history, teacher concern, and examples in two categories: “I can't understand my student” speech examples and “My student doesn't speak enough, is confusing, or

When should a child be referred to speech and language?

Refer by 3 years if the child is using only single words and two words phrases (often consisting of naming words i.e. nouns rather than action words i.e. verbs). uses learned phrases or sentences in many situations even when not appropriate. speech is unclear, even to familiar adults.

How to get a referral for speech therapy?

In addition to contacting your PCP for a referral, if you don't have adequate health insurance and/or can't afford therapy, try contacting local colleges/universities that offer Speech-Language Pathology as a major. There is usually a clinic in the program, for students to practice assessing and treating patients.

How to write a speech referral?

However, SLPs need only nine pieces of information to get the ball rolling: name, date of birth, grade, teacher, vision and hearing status, parent concern and history, teacher concern, and examples in two categories: “I can't understand my student” speech examples and “My student doesn't speak enough, is confusing, or

How do I make a referral to speech and language?

To access speech and language therapy services through the NHS, ask your GP, district nurse, health visitor, your child's nursery staff or teacher for a referral. You can also refer yourself to your local speech and language therapy service.

What are the referral criteria for speech and language therapy?

Refer to speech and language therapy if… The child finds it difficult to learn and understand words. The child finds long and complicated instructions hard to understand. The child is only using short, simple phrases with limited vocabulary.

How do I get a referral for speech therapy?

In addition to contacting your PCP for a referral, if you don't have adequate health insurance and/or can't afford therapy, try contacting local colleges/universities that offer Speech-Language Pathology as a major. There is usually a clinic in the program, for students to practice assessing and treating patients.

For pdfFiller’s FAQs

What is Speech and Language Referral Form?

The Speech and Language Referral Form is a document used to refer individuals, typically children, for assessment and support regarding speech and language difficulties.

Who is required to file Speech and Language Referral Form?

Parents, guardians, and professionals such as teachers, pediatricians, or speech-language pathologists are typically required to file the Speech and Language Referral Form.

How to fill out Speech and Language Referral Form?

To fill out the Speech and Language Referral Form, provide the individual's personal details, describe the specific speech and language concerns observed, include any relevant background information, and sign the form.

What is the purpose of Speech and Language Referral Form?

The purpose of the Speech and Language Referral Form is to formally request an evaluation for speech and language services to address communication challenges.

What information must be reported on Speech and Language Referral Form?

The form must report personal information about the individual, details of observed speech and language issues, prior interventions attempted, and any other relevant medical or educational history.