Client History Forms
Intake Forms
Below are the forms necessary for new patients to be seen at WWU's Aural Rehabilitation Clinic. If you have questions about which forms to complete, or how best to complete them please reach out to our front desk at (360) 650-3881.
Once the forms are completed, please attach forms and send back in an email to SLHclinic@wwu.edu
If you print the forms, please mail to
Speech-Language and Hearing Clinics
516 High Street
AIC 256, MS 9171
Bellingham, WA 98225
Aural Rehabilitation Intake Forms
Audiology Adult Client Intake Form
- Fillable PDF
- Print Word
Audiology Pediatric Client Intake Form
- Fillable PDF
- Print Word
Speech-Language Adult Intake Form
- Fillable PDF
- Print Word
Speech-Language Pediatric Intake Form
- Fillable PDF
- Print Word
Clinic Consents and Policies Form
- Fillable PDF
- Print Word
En Español
Clínica del habla y el lenguaje: formulario de admisión para pacientes adultos
- Imprimir Word
Clínica del habla y el lenguaje: formulario de admisión para pacientes pediátricos
- Imprimir Word
Formulario de consentimientos y políticas de la clínica
- Imprimir Word
Formulario de Informacíon del Paciente
- Imprimir
Clínica de Audiología: Formulario de Historial Médico para
Adultos
- Imprimir
Clínica de Audiología:
Formulario de Historial Médico para Bedés y Niños
- Imprimir