Client Forms

The following client forms are available to clients for download at any time. All forms are listed in alphabetical order. Forms are currently available in English and in Spanish. For questions or clarification, please contact slpclinic@widener.edu.

Client Forms: English

Adult Intake Form

Attendance Policy

Authorization to Release Clinical Records

Client Handbook

Clinic Rules

Clinical Services Consent

E-mail Consent Form

Emergency Contact Form

HIPAA Notice of Privacy Practices

Medical Release Form

Nondiscrimination Statement

Pediatric Intake Form

Client Forms: Spanish

Adult Intake Form Spanish

Attendance Policy Spanish

Authorization to Release Clinical Records Spanish

Client Handbook Spanish

Clinic Rules Spanish

Clinical Services Consent Spanish

E-mail Consent Spanish

Emergency Contact Form Spanish

HIPAA Notice of Privacy Practices for Clients Spanish

Medical Release Form Spanish

Nondiscrimination Statement Spanish

Pediatric Intake Form Spanish