Client Resources
Below you will find links to forms that you may be asked to complete prior to your visit, along with links to additional resources:
Intake Forms
- Agreement to Pay/Insurance Release Form
- Medication Form
- Authorization for Release or Use of Protected Health Information
- Adult Case History
- Pediatric Case History
- Client Handbook
- Cleveland Hearing & Speech Center Client Rights and Responsibilities
- Community Center for the Deaf Client Rights and Responsibilities:
- Notice of Privacy Practices
- Client Grievance Procedure
- Speech Language and Learning Attendance Policy
Scope of Services
- Audiology Scope of Service
- Speech Language and Learning Scope of Service
- Community Center for the Deaf Scope of Service
COVID-19 Resources
- Communication Action Plan
- Communication in the Hospital
- Hard of Hearing Sign
- Communicating While Wearing a Mask (VIDEO)
- Masks and Hearing Aids (VIDEO)
Performance Evaluation Reports
- Audiology 2022 Performance Evaluation Report
- Audiology 2021 Performance Evaluation Report
- Audiology 2020 Performance Evaluation Report
- Audiology 2019 Performance Evaluation Report
- Audiology 2018 Performance Evaluation Report
- Audiology 2017 Performance Evaluation Report
- Speech Language and Learning 2023 Performance Evaluation Report
- Speech Language and Learning 2022 Performance Evaluation Report
- Speech Language and Learning 2021 Performance Evaluation Report
- Speech Language and Learning 2020 Performance Evaluation Report
- Speech Language and Learning 2019 Performance Evaluation Report
- Speech Language and Learning 2018 Performance Evaluation Report
- Speech Language and Learning 2017 Performance Evaluation Report
- Community Center for the Deaf 2022 Performance Evaluation Report
- Community Center for the Deaf 2021 Performance Evaluation Report
- Community Center for the Deaf 2020 Performance Evaluation Report
- Community Center for the Deaf 2019 Performance Evaluation Report
- Community Center for the Deaf 2018 Performance Evaluation Report
- Community Center for the Deaf 2017 Performance Evaluation Report