Speech Therapy Referral Forms

Making or receiving a great speech therapy referral can have a positive impact on our job and day-to-day interactions.  What was once a cumbersome and dreaded process now

alleviates problems rather than create them.  We work across dozens of districts and hundreds of campuses and have tested the forms below until they rated high on the happy meter for teachers, administrators, and speech pathologists alike. Just four pages from the referral packet get you ALL the information you need to create a solid referral.  Then, targeting ONLY the area that the teacher is concerned about saves buckets of time.   

How are effective speech therapy referrals different?

  • Children get the services they need quickly
  • Speech pathologists don’t evaluate students who do not qualify
  • Teachers are not burdened by paperwork and can help their students
  • Our time is spared and the correct children are entering special education

         Press any button below to jump directly to a document

speech therapy referral

Indications for Making a Speech Therapy Referral for Young Children

Here are some quick guidelines for making a referral of young children.  By saying a child is “impaired” we are basically saying that their language or speech is not as developed as other children their age.  It is helpful to know when abilities typically develop.

Speech Intelligibility

For parents:    (Lynch, Brookshire & Fox, 1980)

  • 18 months – ~25% intelligible
  • 2 year olds  – 50-75% intelligible
  • 3 year olds  – 75%-100% intelligible

For unfamiliar listener:     (Flipsen, 2006)

  • 18 months – ~25% intelligible
  • 2 year olds  – 50% intelligible
  • 3 year olds  – 75% intelligible
  • 4 year olds – 100% intelligible

Vocabulary Development

  • 12 months – first words (usually labeling familiar objects, and  actions in child’s environment)
  • 15 months –  4-6-word vocabulary
  • 18 months – 20-50-word vocabulary
  • 24 months – 200-300 word vocabulary
  • 36 months – roughly 1000 words
  • Overextensions (calling all men Dada)Underextensions (calling a tiger Kitty)


Additional References to Make a Referral to Speech Therapy

Speech Referral Guidelines from ASHA

Dysphagia Speech Pathology Referrals

What are the Indications for a Referral to Speech Therapy?