GOEPFERT SPEECH ASSOCIATES, LLC
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GOEPFERT SPEECH ASSOCIATES, LLC

DOCUMENTS
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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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