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Speech-Language Evaluation Report Template
A speech-language evaluation report records the assessment that sets the diagnosis, the baseline, and the goals that therapy will track. Copy the free template, see a school-age language example and an adult post-stroke example, and check what goes in each section.
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Blank speech-language evaluation report template
FreeSPEECH-LANGUAGE EVALUATION REPORT Patient: [Name] Date of birth: [Date] Age at evaluation: [Years and months] Date of evaluation: [Date] Referred by: [Name and role] Languages: [Languages used at home, school, or work; interpreter used or not] Evaluator: [Name, credentials] BACKGROUND Reason for referral: [The referral question and main concerns, in the family's or patient's words] Medical history: [Diagnoses, neurological events, hospital stays, medications] Development or prior function: [Milestones for a child; communication and swallowing before the illness for an adult] Education or work: [School placement and supports, or occupation] Previous services: [Earlier therapy, and the outcome] HEARING AND ORAL MECHANISM Hearing: [Screening result today, or the latest audiology result, and any devices] Oral mechanism: [Structure and function of lips, tongue, jaw, palate, and teeth; diadochokinetic rates] STANDARDIZED TESTS Tests given: [Full name and edition of each test] Scores: [Standard scores, percentile ranks, and confidence intervals where the manual gives them] Validity: [Anything that limits the scores, such as attention, language background, norms, or changes to administration] LANGUAGE Receptive language: [Understanding of words, directions, sentences, and stories or conversation] Expressive language: [Vocabulary, sentence structure, grammar, narrative, word finding] Pragmatics: [Turn-taking, topic maintenance, repair] Language sample: [Context, number of utterances, and key measures] SPEECH Articulation and phonology: [Sound errors, patterns, stimulability, intelligibility] Fluency: [Type and frequency of disfluencies, secondary behaviors] Voice and resonance: [Pitch, loudness, quality, resonance] Motor speech: [Signs of dysarthria or apraxia of speech, or none] SWALLOWING Screening: [Swallowing screen or clinical swallow evaluation, or not assessed and why] Findings: [Position, consistencies and how given, oral and pharyngeal signs, signs of aspiration] IMPRESSIONS Diagnosis: [Communication or swallowing diagnosis, with severity] Supporting findings: [Scores and observations behind it] Strengths: [What the patient does well] Prognosis: [Prognosis for improvement, and what affects it] RECOMMENDATIONS Therapy: [Recommended or not; frequency, session length, setting, and duration] Referrals: [Audiology, physician, instrumental swallowing study, or others] Strategies: [For the family, teachers, or care staff] Diet and safety: [Diet texture and liquid level, positioning, supervision, if swallowing was assessed] GOALS Long-term goal: [Functional outcome for the plan of care] Short-term goal 1: [Behavior, condition, accuracy criterion, cue level, and time frame] Short-term goal 2: [Behavior, condition, accuracy criterion, cue level, and time frame] Discussed with: [Patient, family, or team, and their agreement with the plan] Signed: [Clinician name, credentials, date and time]
Use it for
- Initial evaluations
- Annual re-evaluations
- School-age referrals
- Post-stroke referrals
- Outpatient rehab intake
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Speech-language evaluation: school-age language disorder
Outpatient clinic, initial evaluation, child with her parents
Background
8-year-old girl, referred by her family physician at her parents’ request. Parents and teacher report trouble following multi-step directions, retelling events, and answering questions about stories. English is the only language at home. Born at term; first words at 18 months, two-word phrases at about 30 months. Frequent ear infections before age 3, none since. No previous speech-language services. In a regular classroom, with small-group reading support.
Hearing and oral mechanism
Passed a pure-tone hearing screen in both ears at 20 dB HL at 1000, 2000, and 4000 Hz. Oral structures and function adequate for speech; diadochokinetic rates within normal limits for age.
Standardized tests
Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5): Core Language Score 77, 6th percentile; Receptive Language Index 82, 12th percentile; Expressive Language Index 75, 5th percentile. Peabody Picture Vocabulary Test, Fifth Edition (PPVT-5): standard score 94, 34th percentile. Both tests have a mean of 100 and a standard deviation of 15. Attentive throughout; results considered valid.
Language
Followed 2-step directions reliably, but only 3 of 8 directions with “before,” “after,” or “unless.” Retold a short story with the characters and setting, but left out the problem and the ending. Word-finding pauses in conversation. Turn-taking and topic maintenance appropriate. Language sample of 50 utterances from conversation and story retell: 2 complex sentences with “because” or “when”; 18% of utterances with grammatical errors, mostly verb tense.
Speech
No speech sound errors in conversation; fully intelligible to unfamiliar listeners. Typical disfluencies only, under 3% of syllables. Voice and resonance within normal limits. No signs of a motor speech disorder.
Swallowing
Not assessed. No feeding or swallowing concerns reported.
Impressions
Developmental language disorder, moderate, affecting expressive more than receptive language. Supported by the CELF-5 Core Language Score of 77, difficulty with directions that use time and condition words, missing story structure, and grammatical errors in the language sample. Vocabulary is a relative strength. Prognosis good, with consistent therapy, an engaged family, and support at school.
Recommendations
Speech-language therapy twice weekly, 30 minutes, for 12 weeks, then review. Share this report with her school team, with her parents’ consent, and link goals with her reading support. Classroom strategies: give directions in short chunks, add a visual, and check understanding by asking her to say them back. Consider a reading assessment if reading comprehension concerns continue.
Goals
Long-term goal: understand and use complex sentences to follow classroom directions and retell events. Short-term goal 1: follow 2-step directions with “before” and “after” with 80% accuracy and minimal cues, within 12 weeks. Short-term goal 2: retell a short story with the characters, setting, problem, and ending in 4 of 5 retells, using a visual story map faded to none, within 12 weeks. Results and goals discussed with her parents, who agree with the plan.
Speech-language evaluation: adult after stroke, with swallowing
Acute care hospital, bedside evaluation, day 2 after stroke
Background
72-year-old man, day 2 after a left subcortical ischemic stroke. Referred by the admitting team for slurred speech, and for coughing on water during the nursing swallow screen; nothing by mouth since. History of hypertension and type 2 diabetes. Lived at home with his wife and drove before admission; no previous speech or swallowing problems. Retired bookkeeper. English speaking.
Hearing and oral mechanism
Hears conversation without difficulty; no hearing aids. Right lower facial weakness, with reduced lip seal on the right. Tongue deviates to the right on protrusion, with reduced strength on the right. Soft palate rises symmetrically. Own teeth, in fair repair. Alternating motion rates slow and imprecise.
Standardized tests
Montreal Cognitive Assessment (MoCA): 26/30, within the normal range. Language and motor speech assessed with informal bedside tasks, below.
Language
Followed 3-step directions and answered complex yes or no questions accurately. Named 20 of 20 objects. Conversation fluent and organized, with no word-finding difficulty. Read and wrote short sentences without errors. Language within functional limits.
Speech
Mild dysarthria: imprecise consonants and a slightly slow rate; voice quality normal at rest. About 90% intelligible to an unfamiliar listener in conversation in a quiet room. No signs of apraxia of speech. Fluency within normal limits.
Swallowing
Clinical swallow evaluation, sitting fully upright, after oral care. Ice chips and thin liquid by teaspoon: timely swallow, no signs of aspiration. Thin liquid by cup: coughed after 2 of 5 sips, wet voice after 1. Mildly thick liquid, IDDSI Level 2, by cup: no signs in 5 sips. Puree: no signs; mild residue in the right cheek, cleared with a cue to swallow again. Soft and bite-sized solid: slow chewing, with food held in the right cheek. A bedside evaluation cannot rule out silent aspiration.
Impressions
Mild oropharyngeal dysphagia, with signs of possible aspiration on thin liquids by cup and reduced oral control on the right. Mild unilateral upper motor neuron dysarthria from right facial and tongue weakness. Language and cognitive screen within normal limits. Prognosis good: early after the stroke, mild deficits, motivated, and well supported.
Recommendations
Instrumental swallowing assessment, videofluoroscopic or endoscopic, within 1 to 2 days. Until then: minced and moist solids, IDDSI Level 5, and mildly thick liquids, IDDSI Level 2, by cup in small single sips. Sit fully upright for all intake and for 30 minutes after; supervised meals; check the right cheek for food after each mouthful; oral care twice a day. Medications whole, one at a time in puree, unless pharmacy advises otherwise. Plan given to nursing and posted at the bedside. Speech therapy daily while admitted.
Goals
Long-term goal: eat and drink the least restrictive diet safely, and speak intelligibly in conversation with unfamiliar listeners. Short-term goal 1: clear food from the right cheek with a tongue sweep after each mouthful, with minimal cues, in 9 of 10 opportunities across 3 meals, within 1 week. Short-term goal 2: 95% intelligibility in conversation using a slower rate and clear consonants, with minimal cues, within 2 weeks. Results and plan discussed with him and his wife, who agree.
What goes in each part.
Background
The context a reader needs to interpret your results: why the patient was referred, and the history that bears on communication or swallowing.
- The referral question, in the referrer’s or family’s words
- Medical, developmental, and school or work history
- Languages used, and whether an interpreter was used
- Previous services and their outcome
Avoid: Copying the whole referral or chart. Keep what bears on the question you were asked.
Standardized tests
What you gave and what it showed, reported so another clinician can check it.
- Each test’s full name and edition
- Standard scores and percentile ranks
- Confidence intervals, where the manual gives them
- Anything that limits validity, such as attention, language background, or norms that don’t fit
Avoid: Reproducing test items in the report. Name the test, report the scores, and describe performance in your own words.
Swallowing
Whether swallowing was screened or evaluated, what was trialed, and what you saw.
- Why it was or wasn’t assessed
- Position, consistencies, and how each was given
- Signs of aspiration, such as coughing, throat clearing, or a wet voice
- The limits of a bedside evaluation
Avoid: Writing “no aspiration” after a bedside evaluation. You can report no signs of aspiration; ruling out silent aspiration needs an instrumental study.
Impressions
Your diagnosis or clinical impression, its severity, and the findings behind it.
- The diagnosis and severity
- The scores and observations that support it
- Strengths as well as needs
- Prognosis, and what affects it
Avoid: Leaving the reader to interpret the scores. Say in plain words what they mean for school, work, or daily life.
Recommendations
What should happen next, and who needs to know.
- Therapy: whether, how often, how long, and where
- Referrals, such as audiology or an instrumental swallowing study
- Strategies for the family, teachers, or care staff
- Diet and safety recommendations, when swallowing was assessed
Avoid: Recommending therapy with no frequency or duration. A plan of care needs both.
Goals
Measurable goals that follow from your impressions, for each session note to track.
- A functional long-term goal
- Short-term goals with the behavior, condition, criterion, and time frame
- The cue level for each goal
- The patient’s or family’s agreement
Avoid: Goals like “improve language skills.” A goal needs a target, an accuracy criterion, and a time frame.
Common mistakes, and how to avoid them.
Diagnosing before hearing is checked
A language or speech result means little until hearing is known. Record a hearing screen or a recent audiology result, and refer when the screen is failed.
Scores with no plain-language meaning
Families and teachers read this report. After the scores, say what they mean, such as “understands simple directions but misses words like before and after.”
Norms that don’t fit the patient
For a child learning two languages, or anyone tested through an interpreter, standard scores can mislead. Take a language history, assess both languages where you can, and say what limits the scores.
Treating a bedside evaluation as the final word
A clinical swallow evaluation can miss silent aspiration. When the risk is high, recommend an instrumental study and say why.
Goals the patient didn’t choose
Goals should reflect what matters to the patient or family, such as following classroom directions or eating safely at home. Record their priorities and their agreement.
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Frequently asked questions.
What goes in a speech-language evaluation report?
The reason for referral and background, hearing and oral mechanism findings, standardized test results, language and speech findings, swallowing if relevant, your impressions and prognosis, recommendations, and measurable goals.
How should I report standard scores in an SLP evaluation?
Give the test name and edition, the standard score, the percentile rank, and the confidence interval if the manual provides one. Most language tests have a mean of 100 and a standard deviation of 15; say what the score means in plain words.
How do I evaluate a child who speaks two languages?
Take a history of when and how each language is used, assess both where you can, with a trained interpreter if needed, and consider dynamic assessment. Say in the report when the test norms don’t represent the child.
Should a speech-language evaluation include swallowing?
Include it when there are feeding or swallowing concerns, a neurological event, or a referral that asks. Otherwise, write that it was not assessed and why. A bedside evaluation can’t detect silent aspiration, so recommend an instrumental study when the risk is high.
Is this speech-language evaluation report template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
More speech-language pathology templates, and guides.
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SLP session note with accuracy and cue levels for each goal, for articulation and aphasia.
SLP documentation examples
Evaluation and session note examples for speech-language pathologists.
Vero for speech therapy
Evaluations and session notes, with goals and response kept together.
Common speech pathology codes
The diagnosis codes speech-language pathologists use most.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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