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Save the profile information and complete a detailed articulation assessment.
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Patient Portal
and begin their therapy sessions.
Basic Profile
Speech Assessment
Medical History & Reports
Speech Sample
Additional Notes
Patient Full Name
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Patient History
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Observation
Lips
Tongue
Teeth
Hard Palate
Soft Palate
Uvula
Mandible
Hearing
Others
Lip Appearance
Normal
Cleft
Puckering
Normal
Affected
Retraction
Normal
Affected
Tongue Appearance
Normal
Tongue Tie
Too Short
Too Long
Tongue Thrust
Protrusion
Normal
Affected
Lateral Movement – Left
Normal
Affected
Lateral Movement – Right
Normal
Affected
Elevation
Normal
Affected
Retroflection
Normal
Affected
Ability to Swallow
Saliva
Liquids
Solids
Teeth
Normal Bite
Under Bite
Overbite
Missing Teeth
Supernumerary
Ability to Chew
Normal
Affected
Hard Palate – Appearance
Normal
Cleft
Cleft – Right
Cleft – Left
Cleft – Both
Cleft – Submucous
Height
Select
Normal
High
Low
Width
Select
Normal
Wide
Narrow
Soft Palate – Appearance
Normal
Cleft
Short
Movement during production of /a/
Select
Normal
Inadequate
Sluggish
Deviation (Right)
Deviation (Left)
Symmetry of Movement
Symmetrical
Asymmetrical
Ability to Suck Through Straw
Present
Absent
Ability to Blow
Paper Bits
Candle
Balloon
Blowing Performance Grade
Select
Present
Difficult
Absent
Uvula
Normal
Bifid
Absent
Mandible – Appearance
Normal
Micrognathia
Macrogranthia
Symmetrical
Asymmetrical
Mandible – Function
Normal
Deviation (R)
Deviation (L)
Exaggerated (Jerky)
Modality
Without Reinforcement
With Reinforcement
Auditory
Select
Present
Absent
Partial
Select
Present
Absent
Partial
Others
Articulation Test Results
Brief History of the Problem
Communication Model at Home
Does articulation defect show in writing also?
Yes
No
Intelligibility Score
0
1
2
3
4
5
About Patient
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