Speech Language Pathologists, Nancy L. Foreman and Associates, SPEECH is the WINDOW and MIRROR of the MIND

Slow or stagnant speech development

Consistently hoarse voice

General Case History: Child - Page 2 of 5

 

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** Patient Name:      
** Email Address:      
Date: 

SECTION II – SCHOOLS

Name of the Child’s School: 
School District: 
Teacher: 
What grade is the child in presently? 
Has he repeated any grades? 
If so, what grades? 
What grade is he now making in:  Reading?  Spelling?
Arithmetic?   Writing?   Conduct?
Has the child had any special problems in school?
If so, explain: 

SECTION III – BEHAVIOR AT HOME

Describe any behavior which 
is a problem to the parents: 
Does the child have any close friends?
Does the child play actively with other children?
Does the child care for himself (dressing, eating, etc.) like other children his age?
Does the child have trouble sleeping? 
Have frequent nightmares? 
Have unusual or strong fears? 

 

 

 

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