Forms

The forms below may be filled out on your computer using Adobe Acrobat Reader (available for free from Adobe). The form can then be emailed to the clinic at arehm@uca.edu We cannot guarantee that your email communication with us will be secure. If you do not want to use Adobe Reader and submit the application online, you can print the form and fax or mail it to the clinic.

 

Evaluation Forms:

Adult Evaluation Form

Child Evaluation Form

Aphasia Adult Evaluation Form

Audiology Adult Evaluation Form

Audiology Child Evaluation Form

Fluency (Stuttering) Adult Evaluation Form

Fluency (Stuttering) Child Evaluation Form

Literacy Child Evaluation Form

Adult Voice Evaluation Form

 Privacy Forms:

Notice of Privacy Practices

Acknowledgment of receipt of NPP

Registration Forms:

Registration Form Therapy-Fall 2022