Client Information Profile

The information you provide will help the Speech-Language Pathologist gain a thorough understanding of your child and enable provision of the most appropriate service and management.


  • Identifying and Family Information

  • MM slash DD slash YYYY
  • 1. Parent/Guardian

  • 2. Parent/Guardian

  • Speech, Language, Learning and Hearing

  • Birth History

  • Medical History

  • Developmental History

  • Educational History

  • General Behavior

  • Additional Comments/ Other relevant information

  • This assists us connecting you with a clinician who can match your schedule. Please list your availability using the following format: (e.g., Monday: 9:00 to 12:00, Tuesday: all day, Wednesday: 3:30 to 6:00, or n/a if this day doesn't work for your schedule.)

  • Additional Comments about Availability: (if you don't have a consistent schedule, and need to go week by week, please indicate so and some possible options for availability)

  • MM slash DD slash YYYY

To our valued clients:

The College of Speech and Hearing Health Professionals of BC (CSHBC) has permitted speech-language service to begin for in-person services. Based on the lastest development in BC and starting June 1, 2020 Semiahmoo Speech Services Inc. will provide some in-person assessment and therapy services. As well, we will continue to encourage virtual services when possible with our clients.

Please review our Safety Protocol on the website as well as our Self-Assessment for COVID-19. This information oultines our safety guidelines and changes in how we are operating inside the clinic to allow for a safe and healthy service at our office.

We look forward to seeing all of you soon!

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