GOEPFERT SPEECH ASSOCIATES, LLC
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March, 2024
I am thrilled to share my positive experience that Goepfert Speech Associates provided for my daughter. From the moment we enrolled her in the services, we noticed significant improvements in her communication skills. Both Gayle and Jill were not only highly skilled professionals, but also compassionate individuals who made the sessions engaging and fun for my daughter. With their tailored approach and dedication, my daughter gained confidence in expressing herself and overcoming speech challenges. I am immensely grateful for the invaluable support and guidance provided by them, which have truly transformed my daughter's life for the better.

Erica R.



GOEPFERT SPEECH ASSOCIATES, LLC

DOCUMENTS
:

Below is a list of documents for you to download and print to complete and return to the office prior to your appointment for review.


1. About Goepfert Speech Associates, LLC
PDF Download
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2.  Child History Form

Word Document Download
Fillable PDF
3.  Release Form
Word Document Download
Fillable PDF
4.  Confidentiality Form
Word Document Download
​5.  Treatment Contract
Fillable PDF
Fillable PDF
6.  Health Insurance Claim Form (HICF)
Fillable PDF
7.  Health Insurance Protection and Portability Act  (HIPPA) Form

Word Document Download
Fillable PDF




Additional Optional Documents:

8.  Childhood Onset Speech Fluency (Stuttering) Questionnaire for Parents to complete
Word Document Download
Fillable PDF
9.  Adult Speech Fluency (Stuttering) Questionnaire
Word Document Download
Fillable PDF
10.  Pragmatic Language Chart Checklist     3 pages
Pragmatic Language Chart Checklist- Fillable PDF

11.  Adult  History Form   4 pages
Word Document Download

12.  Transgender Clients TVQ- 1 page
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TVQ Questionnaire-Fillable PDF
13. Adult Voice History
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Fillable PDF
Fillable PDF
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