First Visit Forms

You may type your answers and then print, or print and handwrite your answers. Either way, please bring a completed copy of each form under the appropriate heading with you to your first appointment at the Center. If you have questions, please call 614.263.5151.


AUDIOLOGY: 0 - 5 months



AUDIOLOGY: 6 months – 17 years



AUDIOLOGY: Adult



SPEECH THERAPY: 0 - 3 years



SPEECH THERAPY: 3 - 17 years



SPEECH THERAPY: Adult