Completing our intake form is the first step to receiving services at the BYU Speech and Language Clinic. The easiest way is to fill out the forms online. You may fill them out online by clicking on the link to the appropriate form below.
Online Intake Forms:
Pediatric Intake Form
Pediatric Intake Form (Spanish)
Adult Intake Form
Adult Intake Form (Spanish)
Alternatively, you may download the forms listed below as an editable PDF document. You may need Adobe Reader to fill out the form. Then email the form to byuspeechclinic@byu.edu or print and mail the form to:
Speech and Language Clinic
Department of Communication Disorders
Brigham Young University
1190 North 900 East
Provo, Utah 84602
Printable PDF Intake Forms:
Pediatric Intake Form
Pediatric Intake Form (Spanish)
Adult Intake Form
Adult Intake Form (Spanish)