Forms

If you are pursuing services from the Center for Communication Sciences & Disorders, please complete these two forms.

1. Enrollment Form – This gives us the necessary information to proceed with enrolling you in Clinical Services.
2. Sliding Fee/Scholarship Information – Complete this form if you'd like to be considered for reduced clinical fees or scholarships.

Release Forms

• Release of Information Form
• Image Release and Waiver Form
• Center Research Consent: Adult Form
• Center Research Consent: Child Form

Additional Forms

• Aphasia Support Group Enrollment:
  • Aphasia Group 1, Wednesdays 10:00-11:30
  • Aphasia Group 2,  Mondays 1:00-2:30 pm
• Social Skills Group Enrollment:
  • Elementary
  • Middle School/High School
  • Young Adult
• Notice of Privacy Practices of Protected Health Information & Patient Rights

Satisfaction Surveys

• Client Satisfaction Survey
• Stroke Survivor Satisfaction Survey