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CLIENT HISTORY FORM Ages 518 16500 Ventura Blvd. #414 Engine, CA 91436 5901 Green Valley Circle, #130 Culver City, CA 90230 (818) 7881003 (fax) 818 7881135 www.speechassociates.com CLIENT HISTORY

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Ages 5-18 are typically required for various purposes including enrollment in educational institutions, participation in youth programs or activities, and obtaining certain services or benefits that are age-restricted. Parents or legal guardians of children in this age range typically need to fill out this information for their children.

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