• Speech Therapy Screening Consent Form

  • Developmental Screening Information


    At Pinnacle Therapy MT, I am dedicated to helping children grow, communicate, and thrive. I provide speech and language therapy and myofunctional therapy services to support children’s communication development.

    I am excited to partner with your child’s daycare/preschool to offer FREE speech and language screenings. These screenings help identify children who may benefit from further evaluation or early intervention services.

    What Are the Screeners?
    PLS-5 Language Screener
    The Preschool Language Scales (PLS-5) Screener is a research-based tool used to assess:

    ·       Receptive language (how well a child understands language)

    ·       Expressive language (how a child uses words, phrases, and sentences)

    This screening helps determine whether your child’s language skills are developing as expected for their age or if further evaluation may be recommended.

    Articulation Screener
    The articulation screener evaluates how clearly your child produces speech sounds. It helps identify sound errors or patterns that may affect how easily your child is understood by others.
    Both screeners are brief, play-based, and designed to be engaging and comfortable for children.

    Why Is Screening Important?
    Early identification of speech and language differences allows children to receive support as soon as possible.

    If your child “screens in” for services, this is not a diagnosis. It simply means that a comprehensive speech-language evaluation may be beneficial.

    Early support can help:

    ·       Strengthen communication and learning skills

    ·       Improve social interaction and confidence

    ·       Provide families with strategies to support development at home

     

    Next Steps

    1. Screening Results: You will receive a summary of your child’s screening results via email.

     

    2. Referral for Evaluation (if recommended): If your child’s screening suggests the need for further assessment, we will discuss the process for scheduling a formal evaluation and will contact you by phone.

     

    3. Collaboration: If therapy is recommended, I will work with you to develop a personalized plan to best support your child’s needs. I currently offer mobile therapy services in Helena.

    If you have any questions or concerns, please feel free to reach out.  Thank you for your partnership in supporting your child’s growth and development.

    Sincerely,

    Audriana Lockerby, M.S., CCC-SLP

    Owner, Pinnacle Therapy MT

    audriana@pinnacletherapymt.com

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • I authorize Pinnacle Therapy MT to administer the PLS-5 language and articulation screeners to my child. I understand that these screenings are used to identify potential speech and language concerns and that further evaluation may be recommended if my child qualifies based on screening results.  I understand that this screening is not a formal diagnosis and agree to discuss recommended next steps if needed.

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