Pediatric Documentation Templates

The templates included here are provided as a resource only and do not represent ASHA policy. To request customizable templates in Word format, please e-mail and indicate which templates you would like to receive. These templates were developed by a work group of affiliates from Special Interest Group 13 (Swallowing and Swallowing Disorders [Dysphagia]).

Available Templates

Feeding History and Clinical Assessments

User's Guide to Pediatric Clinical Feeding Assessment Templates [PDF]

Pediatric Clinical Assessment Template (Liquids only) [PDF]

Pediatric Clinical Assessment Template (Liquids, semi-solid and solid foods) [PDF]

Speech and Language Assessments

Pediatric Stuttering Assessment Template [PDF]

Videofluoroscopic Swallowing Studies

Infants (Consuming liquids only) [PDF]

Children (Consuming liquids and solids) [PDF]

ASHA Corporate Partners