
Get the free Does My Child Have a Speech Problem? A Case History Form
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Child Case History Form Date: Please list all ages and relationships of others living in the home with the child: Languages spoken in the home: Have any family members had speech, language, hearing,
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Does your child have any allergies or medical conditions?
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Parents or legal guardians are required to fill out the form for their child.
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You can fill out the form online or submit a physical copy to the school or daycare.
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The form helps to ensure that caregivers are aware of any medical conditions or allergies that a child may have.
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You must report any allergies, medical conditions, or medications that your child is currently taking.
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