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:
  • Plain Language Version
  • Video ASL Version
• 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