Free speech therapy template

Speech therapy assessment report template and sample

A speech therapy assessment report format that takes you from referral to recommendations, with a sample entry for each findings section.

Covers referral to recommendations
Sample entries for every findings section
Fill in online, download PDF

Free · No sign-up · Saves in your browser · Built into healhab as “Comprehensive Speech and Language Assessment”

What's inside

Reason for Referral and Priorities
Background Information
Assessment Information and Sources
Hearing, Vision, and Access Considerations
Oral Peripheral and Motor Speech Observations
Receptive Language
Expressive Language
Speech Sound Production and Intelligibility

+ 8 more sections

Comprehensive Speech and Language Assessment

Patient		Patient ID
Date of birth		Assessment date
Therapy		Therapist
Languages		Referred by

Reason for Referral and Priorities

Reason for referral

Patient caregiver priorities

Background Information

Relevant medical developmental history

Communication development history

Education social context

Languages and communication modes

Assessment Information and Sources

Assessment methods and sources

Participation and observation context

Hearing, Vision, and Access Considerations

Hearing vision accessRecord only information explicitly reported or observed.

Oral Peripheral and Motor Speech Observations

Oral peripheral observations

Motor speech observations

Receptive Language

Receptive language findings

Expressive Language

Expressive language findings

Speech Sound Production and Intelligibility

Speech sound findings

Intelligibility and functional impact

Fluency

Fluency findings

Voice and Resonance

Voice resonance findings

Social and Functional Communication

Social communication findings

Functional communication impact

Strengths and Support Needs

Observed/Reported Strengths	Areas Requiring Support

Clinical Summary

Clinical summarySummarize explicit source facts without adding clinical conclusions.

Impression

Clinical impression

Recommendations and Next Steps

recommendationsRecommendations remain clinician-authored or suggestions until reviewed.

Referrals follow up

Therapist Sign-off

Therapist	Designation	Registration	Date

How to fill it in

Reason for Referral and Priorities
Who referred, what they asked, and the family's own priorities in their words.
More guidance
State who referred the person, the question they asked, and the family's or client's own priorities in their words. Keep the two apart. A school may be worried about reading while a parent is worried about being understood by grandparents. Note the date of referral and any letter or report that came with it.
Background Information
Relevant history and every home language, with the source of each fact.
More guidance
Summarise the relevant medical and developmental history, education and social setting, drawing on the case history form. Record every language used at home, who uses it with the person, and which language you assessed in. Write "as reported by mother" or "from discharge summary dated…" so the source of each fact is clear to any later reader.
Assessment Information and Sources
Each method and test you used, and the conditions on the day.
More guidance
List each method you used: play-based observation, a conversation or narrative sample, parent interview, teacher input, and any published test by name and edition. Note the conditions, including session length, who was present, and anything that may have affected performance, such as tiredness, a new setting or working through an interpreter.
Hearing, Vision, and Access Considerations
Only documented hearing results and observed access needs; flag a missing hearing test.
More guidance
Record only what is documented or directly observed: the date and outcome of the last hearing test as written in that report, glasses, hearing aids, and access needs such as a wheelchair or a communication device. If no hearing test is on record, say so and carry it into the recommendations rather than guessing about hearing.
Oral Peripheral and Motor Speech Observations
Describe structure and movement as observed; leave interpretation to the impression.
More guidance
Describe structure and movement as you observed them: lips, tongue, palate, teeth, and how the person managed non-speech and speech movement tasks. Write what you saw, such as reduced range, groping or slow alternating movements, rather than naming a condition in this section. Leave interpretation to the impression.
Receptive Language
What the person understands, in each language, and the support given.
More guidance
Cover what the person understands: instructions of increasing length, vocabulary, questions, concepts and stories, in each language assessed. Give the conditions, for example with or without gestures and pictures, because support changes what a person can show you. If you used a published test, report its result exactly as the manual describes it.
Expressive Language
How the person puts words together, shown with a few transcribed utterances.
More guidance
Describe how the person puts words together: vocabulary, sentence length and structure, grammar, storytelling, and the reasons they communicate. A few transcribed utterances are worth more than adjectives. Count gestures, signs, pictures and devices as part of expression, and say which language the person used with whom.
Speech Sound Production and Intelligibility
Which sounds were in error, at what level, and who understands the person.
More guidance
Record which sounds and patterns were in error, at what level (single words, phrases, conversation), and whether errors were consistent. Describe intelligibility in daily terms: who understands the person, in which settings, with or without knowing the topic. Keep this section descriptive and leave classification to your impression.
Fluency
Types of disfluency, where they happened, any tension, and how the person feels.
More guidance
Describe the types of disfluency you observed (repetitions, prolongations, blocks), where they happened, any physical tension or extra movements, and how the person and family feel about talking. Say whether you sampled conversation, reading or a monologue. If fluency was typical for the person in your sample, one line is enough.
Voice and Resonance
Pitch, loudness, quality and daily voice use, plus any dated ENT findings.
More guidance
Describe pitch, loudness, quality and resonance as you heard them, and how the person uses their voice: talking over noise, teaching, singing, shouting during play. Record any ENT report in its own words, including whether the larynx has been examined and when. For adults with a voice concern, note whether an ENT review has happened before therapy begins.
Social and Functional Communication
How communication works in daily life, including strengths and preferred ways of connecting.
More guidance
Describe how communication works in daily life: starting and keeping an interaction going, turn-taking, play, how the person repairs a breakdown, and participation at home, school or work. Include the person's preferred ways of connecting and their strengths, as well as what is hard.
Strengths and Support Needs
Fill both columns, tying each support need to a finding above.
More guidance
Fill both columns. Strengths might include interest in people, a strong home language, a grandparent who plays with the child every evening, or good attention in preferred activities. Write support needs in functional terms and tie each one to a finding above, so the treatment plan can draw directly from this table.
Clinical Summary
The key findings from each section in one short paragraph a parent can follow.
More guidance
Bring the key findings from each section into one short paragraph. Do not introduce new information here, and do not reach beyond what your findings show. Mention the main strengths next to the areas of need, and check that a parent could understand the paragraph if it were the only part they read.
Impression
The treating clinician writes and signs this section; no sample wording is offered.
More guidance
The treating clinician writes and signs the professional impression. If you name a condition, base it on your own assessment and professional standards, and say what remains uncertain or needs further assessment. Nothing here should go beyond the evidence recorded in the sections above.
Recommendations and Next Steps
Session frequency, focus, referrals, who acts on each point, and the review date.
More guidance
Make each recommendation specific: frequency and length of sessions, setting, focus areas, home involvement, and referrals with a reason, such as a hearing test or ENT review. Say who should act on each point and when you plan to review. Add one thing the family can start doing at home this week.

Speech therapy assessment report template and sample: filled sample

Fictional entries, initials only, showing the level of detail to aim for. Impression and summary sections are left for the treating clinician.

Reason for Referral and Priorities

Referred by Dr K. (paediatrician) for unclear speech. Mother reports that relatives outside the home understand "very little" of what A. says, and that A. has begun to stop talking when asked to repeat himself.

Background Information

Family speaks Telugu at home; the grandmother, who is the main daytime carer, uses only Telugu. A. attends an English-medium preschool. Assessment was carried out in Telugu and English with his mother present.

Assessment Information and Sources

Two 45-minute sessions in clinic. Play-based observation, parent interview, a 50-utterance language sample during play, and a published articulation test (name and edition recorded). A. had a cold during the first session.

Hearing, Vision, and Access Considerations

No hearing test on record. Parents report two ear infections in the past year. In session, A. turned to his name called from behind at conversational loudness on three of four occasions.

Oral Peripheral and Motor Speech Observations

Rounded and spread lips on request. Raised the tongue tip to the upper lip with visible effort and could not hold it. Repeated "pa-ta-ka" slowly; at a faster rate the sequence broke down after two repetitions.

Receptive Language

Followed two-step instructions with familiar objects when the adult also pointed (4 of 5). Without gestures, followed one-step instructions reliably and two-step instructions on 1 of 5 trials.

Expressive Language

During play R. combined two words ("ball gone", "amma come") and used single words for most requests. He mixed Hindi and English within phrases, as the family does at home.

Speech Sound Production and Intelligibility

Produced /k/ and /g/ as /t/ and /d/ in single words and in conversation ("tar" for "car"). When the topic was unknown, the therapist understood about half of A.'s utterances in play.

Fluency

In a 10-minute conversation S. repeated whole words and first sounds ("I-I-I want", "b-b-bus"). No visible tension. S. said he does not like answering questions in class.

Voice and Resonance

Voice was hoarse throughout the session and quieter towards the end. Mrs P. teaches four classes a day and reports losing her voice by Friday most weeks.

Social and Functional Communication

R. brought toys to show his mother and waited for her to respond. With an unfamiliar adult he joined a turn-taking game after watching for two turns.

Recommendations and Next Steps

Speech therapy twice weekly, 45 minutes, for 12 weeks, focusing on sounds made at the back of the mouth. Hearing test with an audiologist before the first review. Grandmother to join one session each fortnight.

Assessment report vs case history form

	Assessment report	Case history form
Who fills it in	The speech therapist, after the assessment sessions	Parents, carers or the adult client, before the first visit
What it holds	Observations, test results, impression and recommendations	Reported history: health, hearing, languages, concerns and priorities
Clinical judgement	Yes, in the summary, impression and recommendations	None; it records what the family tells you
When it is used	After assessment, and again at re-assessment	Before or at intake, then updated if things change
Who reads it	Family, referrer, school and other professionals, with consent	The therapist and the treating team

Tips and mistakes to avoid

Do

Write in the language the family reads best, or add a short translated summary they can act on.
Separate observation from report with phrases like "mother reports" and "observed in session".
Name each published test and edition, and report results only as its manual describes.
With consent, transcribe a few recorded utterances so later progress reports have a real baseline.
In healhab this is the built-in Comprehensive Speech and Language Assessment starter, editable in Template Studio.

Avoid

Writing "speech is unclear" without naming the sounds, the level or who finds it hard.
Assessing only in English when the child mostly speaks another language at home.
Leaving the hearing section blank instead of noting that no test is on file.
Recommending "speech therapy" with no frequency, focus or review date.
Repeating a label from a relative or an old note without naming its source.

About this assessment report

A speech therapy assessment report records why the person was referred, their communication history, what you observed and tested in each area, and what you recommend. This format follows the Comprehensive Speech and Language Assessment structure, with sections for understanding and using language, speech sounds, fluency, voice and social communication. Fill it in online and download a PDF.

First full speech and language assessment, child or adult
Re-assessment at the end of a therapy block
A referrer or school asks for a written report
Handing a case to another therapist

The assessment report, called a speech therapy evaluation in the US, is the document every later goal and progress report points back to. Be exact about what you saw, what was reported and what you tested.

Write it within a week of the sessions for the family, referrer and school. Parents often read it first on a phone, so the summary and recommendations must make sense alone. Delete areas you did not assess.

Questions

What is the format of a speech therapy assessment report?

Identifying details, reason for referral, background, assessment methods, findings by communication area, strengths and needs, summary, impression and recommendations. This format adds hearing and oral motor sections, which are often missed.

Is there a filled sample of this report?

Yes. Each findings section on this page shows a fictional sample entry, using initials only, to show the level of detail. The clinical summary and impression have no sample; the treating clinician writes those from their own assessment.

How long should a speech and language assessment report be?

As long as the findings need. A focused assessment can fit on two pages; a full assessment across several areas may run to five or six. Delete the sections you did not assess.

Can I include standardised test results in this template?

Yes. Name the test and edition, give the date, and report the result exactly as its manual describes it. The template contains no test items and calculates nothing for you.

Is this the same as a speech therapy evaluation template?

Yes. "Evaluation" is the usual US term, while "assessment report" is more common in India and the UK. The structure and purpose are the same.

How do I write the report for a multilingual child?

Record every home language and who uses it. Assess in the child's stronger language where you can, with an interpreter if needed, and say which language each finding refers to.

More speech therapy templates

Assessment report formats for other therapies

Write every report inside your clinic system.

Keep these as your clinic's own templates, write from reviewed session notes, publish branded PDFs, and keep families updated.

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