Practice documents

Begin with clarity, care, and consent.

Print a new-client packet for a parent or caregiver, fill a form in the browser, or open a clinician template for the record. Missing papers should never keep you from showing up.

Every journey begins with hope.

Begin your journey

One click

New client packet.

Registration, case history, consent to treat, HIPAA acknowledgment, release of information, attendance, financial policy, and emergency information—together. Print it blank and hand it off. Bring signed pages to the first visit, or mail them to the P.O. Box. Scan them when you have a scanner—this website does not upload. Teletherapy consent, recording consent, and card-reader authorization can be added if you need them.

Open the packet After the packet

For families

A suggested order for getting started.

Complete a form in the browser, save a draft on this device, print a PDF, or email a summary to the practice. Please review privacy and consent language with your own counsel as needed. For why each paper exists, see Partnership papers.

Step 01 · Family form

Client Intake / Registration

Demographics, contact, physician, school, diagnoses, and communication concerns.

Open form

Step 02 · Family form

Consent for Evaluation & Treatment

Authorize evaluation and speech-language therapy services.

Open form

Step 03 · Family form

HIPAA Privacy & Release of Information

Review privacy practices and authorize care coordination.

Open form

Step 04 · Family form

Therapy Expectations & Family Agreement

A partnership promise between clinician, client, and family.

Open form

Step 05 · Family form

Cancellation & Attendance Policy

How we protect reserved time and support consistent progress.

Open form

Family form

Pediatric case history

Birth, development, school, and communication history for a child.

Open form

Family form

Adult case history

Onset, medical history, and daily communication for an adult.

Open form

Family form

Emergency information

Who to call, allergies, and pickup authorization.

Open form

Family form

Teletherapy consent

A yes for video visits when teletherapy serves the plan.

Open form

Family form

Photo, video, and recording consent

Clinical recordings, internal training, and a separate yes for marketing.

Open form

Family form

Release of information

Who R.O.S.E. may speak with—school, physician, or EI—only when you authorize it.

Open form

Family form

Financial policy

Published consultation and late-cancel fees, and how therapy amounts are named.

Open form

Family form

Payment authorization

Paper authorization for the phone card reader. Not a payment processor.

Open form

For the clinician

Clinician templates

Plan of care, SOAP and treatment notes, progress reports, goal data, home programs, and discharge papers. Families do not fill these pages.

Clinician template

Speech-Language Evaluation Report

Clinical template for documenting evaluation findings and goals.

Open template

Clinician template

Treatment notes

Session documentation with the R.O.S.E. mark faded in the background. For the clinician, not for families to fill.

Open template

Clinician template

Plan of care

Treatment-plan template: goals, named frequency, and caregiver education.

Open template

Clinician template

Daily treatment / SOAP note

Subjective, objective, assessment, and plan for one hour.

Open template

Clinician template

Progress report

Period summary of goals, attendance, and next recommendations.

Open template

Clinician template

Goal / data collection

One goal, baseline, target, and session-by-session data lines.

Open template

Clinician template

Home exercise / home program

A few kind steps for the days between sessions. Print and send home.

Open template

Clinician template

Discharge summary

Dates, reason, goals met, and how communication looks at goodbye.

Open template

Clinician template

Discharge / transition recommendations

What to carry to school, a physician, or the next clinician.

Open template

Private access

Billing desk

Password-protected invoices, superbills, and the IEP fee schedule you keep for yourself. Not a public fee list. Consultation stays $25 per 15 minutes. Therapy amounts are entered only after they were named.

Open private billing

Every bloom begins with R.O.S.E.