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Official Use Onstage of Utah Department of Commerce Division of Occupational and Professional LicensingNumber: Date Approved/Denied: Approved/Denied By: SpeechLanguage Pathologist Audiologist APPLICANT
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To fill out the form for an audiologist and/or speech-language pathologist, follow these steps:
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Start by gathering all necessary information such as personal details, medical history, and contact information.
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Read the instructions provided on the form thoroughly to understand the requirements and guidelines.
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Begin by entering your personal details such as your name, address, phone number, and date of birth.
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Provide information about your medical history, including any previous diagnoses, treatments, or surgeries related to audiology or speech-language pathology.
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Specify the reason for seeking the services of an audiologist or speech-language pathologist, and provide any relevant details or concerns you may have.
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If applicable, provide information about your current healthcare provider or any other professionals involved in your treatment.
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Review the form for accuracy and completeness, making sure all sections are properly filled out.
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Sign and date the form to certify that the information provided is accurate and complete.
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Submit the form according to the specified instructions, either in person, by mail, or electronically.
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Who needs audiologist andor speech-language pathologist?

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Audiologists and speech-language pathologists are needed by individuals who have difficulties with hearing, speech, language, or swallowing.
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The following groups of people may benefit from the services of an audiologist and/or speech-language pathologist:
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- Children with speech or language delays or disorders
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- Adults with communication or swallowing difficulties due to stroke, traumatic brain injury, or other conditions
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- Individuals with hearing loss or auditory processing disorders
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- People with voice disorders or difficulties in producing sounds correctly
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- Those who require assistance in augmentative and alternative communication (AAC) devices
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It is recommended to consult with a healthcare professional or a specialist to determine if the services of an audiologist or speech-language pathologist are necessary in individual cases.
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Audiologists are health care professionals who assess, diagnose, and treat hearing and balance disorders. Speech-language pathologists work with individuals who have communication, speech, or swallowing disorders.
Audiologists and speech-language pathologists who are licensed or certified in their respective fields may be required to file reports.
The reporting requirements for audiologists and speech-language pathologists may vary depending on the jurisdiction. It is important to follow the specific instructions provided by the governing body.
The purpose of reporting audiologist and/or speech-language pathologist information is to ensure compliance with licensing requirements and to maintain accurate records of professionals in the field.
Information such as name, license or certification number, contact information, and any continuing education credits may need to be reported.
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