Speech-Language Evaluation
Client Name:
Date of Evaluation:
Diagnosis:
Date of Birth:
Treatment Diagnosis:
Age:
HISTORY:
CLIENT/CAREGIVER GOALS:
EVALUATION
Hearing:
Voice:
Fluency:
Language:
An informal language screener was administered virtually to achieve baseline data of expressive
and receptive language skills. The client demonstrated the following:
N/A means the target was not screened.
(-) means the target area was not demonstrated by the client.
Target Area
Observations
(+) = demonstrates target
area ability
Receptive Language
(-) = does not
demonstrate target area
ability
Joint Attention
Sustained Attention
Following Directions
1 step:
2 step:
3 step:
With embedded spatial concepts: (in, on, etc…)
With embedded temporal concepts: (before, first,
etc…)
Identification
Body parts:
Familiar objects/pictures:
Actions:
Functions:
Adjectives:
Questions
Yes/no:
Who:
What:
When:
Where:
Why:
Pronouns
Personal: Singular/Plural
Possessive: Singular/Plural
Categorization
Convergent:
Divergent:
Pragmatics
Uses gestures/language
Affect:
Eye gaze:
Requests objects/assistance:
Turn Taking:
Comments:
Questions:
Role-play:
Initiation:
Labels:
Protests:
Greetings/Partings:
Directs:
Expressive Language
MLU
Pronouns
Range:
Labels
Body parts:
Objects/patterns:
Actions:
Verbs
Regular past tense:
Irregular past tense:
Descriptors
Size:
Color:
Texture:
Shape:
Spatial:
Quantity:
Questions
Yes/no:
Who:
What:
When:
Where:
Why:
Defines/Describes
Objects:
Function:
Articulation:
An informal articulation screener was administered virtually to achieve baseline data of speech
sound productions. The client demonstrated the following:
N/A means that the phoneme was not targeted in the screener.
(-) means the phoneme was not demonstrated by the client.
Target Phoneme
p
m
h
n
w
b
g
k
d
t
ŋ
f
y
r
l
s
Initial
Medial
Final
j
ʃ
tʃ
dʒ
θ
v
z
ð
bl
br
dr
fl
fr
gl
gr
kl
kr
kw
pl
sl
sp
st
sw
tr
BEHAVIORAL OBSERVATIONS:
IMPRESSIONS/SUMMARY OF FINDINGS
RECOMMENDATIONS
GOALS