Speech Pathologist Template
LSHS - OT Initial Phone Consult
A professional Speech Pathologist template for healthcare professionals.
About this template
Need to document a phone consultation for a child with speech or language concerns? This **Speech Therapy Initial Phone Consult Template** is designed for Speech Pathologists to efficiently record essential information from a parent or guardian during an initial phone consultation. This template helps capture details about the child's history, current abilities, and parental concerns. With Heidi, this template can be quickly populated from a transcript, saving valuable time and ensuring comprehensive documentation. This template allows you to create detailed and accurate initial assessments, helping you to create effective treatment plans.
Preview template
[Patient First Name]
Phone consult completed with Mother.
CLIENT INFORMATION
**Client Name:**
Oliver Smith
**Date of Birth / Age:**
12/03/2018 / 6 years old
**Legal Guardian:**
Sarah Jones (Mother)
**Personal Information**
Living with:
Oliver lives with his mother, Sarah, and his younger sister, Emily.
Siblings:
Emily, age 4.
Family history:
No significant family history of speech or language difficulties.
School / Grade:
Attends Willow Creek Primary School, Grade 1.
Languages spoken:
English
Likes/Dislikes:
Likes playing with cars and building blocks. Dislikes loud noises and crowded places.
Allied Health Support:
Currently seeing a paediatrician.
Has seen an OT before? What goals were worked on?:
No previous OT.
Main concerns reported:
Mother is concerned about Oliver's speech clarity and difficulty following instructions.
MEDICAL HISTORY
**Pregnancy/Birth:**
Pregnancy Duration:
40 weeks
Maternal Health:
Uncomplicated pregnancy.
Birth Type:
Vaginal delivery.
Birth Health:
Healthy birth, no complications.
**Medical Conditions / Diagnoses:**
None.
**Health History:**
Hospitalisations:
None.
Significant Illnesses:
None.
Epilepsy:
No.
Surgeries:
None.
Orthodontic Treatments:
None.
Tooth Removal:
None.
**Allergies:**
No known allergies.
**Medications:**
None.
**Hearing / Vision:**
Hearing Health:
Hearing within normal limits.
Last Hearing Ax:
10/06/2024
Vision Health:
Wears glasses for mild astigmatism.
Last Vision Ax:
10/06/2024
SCHOOL / CHILDCARE SUPPORTS
**School:**
Name:
Willow Creek Primary School
Grade:
1
Commencement:
February 2024
Attendance Frequency:
Full-time.
**Supports:**
Receives support from a teacher's aide in the classroom.
**Grades:**
Performing at grade level in most subjects.
**Enjoyment:**
Enjoys school and interacting with peers.
**Other:**
None.
DEVELOPMENT HISTORY
**Communication:**
Babbling:
Babbling milestones met at appropriate age.
First Word:
Spoke his first word at 12 months.
Speech/language/communication concern:
Difficulty with articulation, particularly with /s/, /z/, /th/ sounds. Struggles with multi-step instructions.
**Motor:**
Tummy Time:
Met milestones at appropriate age.
Rolling:
Met milestones at appropriate age.
Belly Crawl:
Met milestones at appropriate age.
Crawl:
Met milestones at appropriate age.
Standing:
Met milestones at appropriate age.
Walking:
Met milestones at appropriate age.
**Feeding:**
(See below.)
CURRENT FUNCTIONAL CAPACITY
**Self Care:**
Toileting:
Independent with toileting.
Showering:
Independent with showering.
Dressing:
Independent with dressing.
Feeding:
Independent with feeding.
Brushing Hair:
Requires some assistance with brushing hair.
Brushing Teeth:
Independent with brushing teeth.
**Eating:**
Eats a variety of foods. No significant difficulties.
**Play / Social Interaction:**
Enjoys playing with peers and participates in group activities.
**Fine Motor:**
Fine motor skills are age-appropriate.
**Gross Motor:**
Gross motor skills are age-appropriate.
**Emotional Regulation:**
Generally well-regulated, but can become frustrated when struggling to communicate.
**Sleep:**
Bedtime:
8:00 PM
Sleep Onset:
Falls asleep within 15 minutes.
Sleep Duration:
Sleeps approximately 10-11 hours per night.
Night Waking:
Rarely wakes during the night.
Enuresis:
No.
Sleep Quality:
Good.
Snoring:
No.
Mouth Breathing:
No.
Sleep Walking/Talking:
No.
Thumb Sucking/Dummy Use:
No.
Day Naps:
No.
**Sensory Processing:**
Sensitive to loud noises.
CURRENT NDIS PLAN DATES & GOALS (if applicable)
**Dates**
From:
01/01/2024
To:
31/12/2024
**Goals:**
Improve speech intelligibility.
Increase ability to follow multi-step instructions.
OPEN TO HOLIDAY INTENSIVE THERAPY BLOCK (if applicable)
Yes/No:
Yes
RECOMMENDATIONS:
Recommend speech therapy sessions twice per week.
Recommend home practice activities to support articulation goals.
PLAN:
Weekly speech therapy sessions to address articulation and receptive language skills. Home practice activities will be provided. Referral to an audiologist for a hearing check.
ADMINISTRATIVE TASKS
Inform admin if additional weeks are required before completing your initial summary report (2-week buffer currently in place).
Inform admin if ongoing therapy appointments require removal — they are booked unless stated otherwise.
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Specialty
Speech Pathologist
Used
5 times
Type
Note
Last edited
10/28/2025
Created by
Anonymous