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Getting Started

Case History

The following case history form is intended for children ages 1yr to 18yrs.  If you are interested in receiving a comprehensive speech-language evaluation, please complete the case history form and return it to the Texas State Speech-Language and Hearing Clinic.  You may do this by: 1)  printing the form, completing it and returning it by fax or scanning it and returning it by email; or, 2)  you may complete this form online and submit it electronically. This option requires Adobe Acrobat Reader, and you can download that application from the following link: