Pediatric (ages 0 - 18)

Pediatric Speech and Language Evaluation Questionnaire

Audiology Evaluation Questionnaire (coming soon!)

 

 

 Adult  (18+ )

Adult Speech and Language Evaluation Questionnaire

Audiology Evaluation Questionnaire

International Student Schedule Form (for students requesting ESL services such as accent management)

 

Insurance Billing

The Center for Speech and Hearing does not bill private insurance, Medicaid, or Medicare. 

If you have any questions about our services, please call us at 573-651-2050. 
If you are interested in our services, please fill out the appropriate Case History Questionnaire and send it in:
  • By fax: 573-651-2827
  • By email
  • By mail: Center for Speech and Hearing, One University Plaza, MS2600, Cape Girardeau, MO 63701
Once we receive your information, we will contact you about scheduling an appointment.
 

 

Additional Forms

Emergency Procedures for Center for Speech and Hearing
Field Trip Permission Form
Liability Release when Traveling Off-Campus (Students)
Liability Release when Traveling Off-Campus (Clients)
 

Clinic Inventory 

Clinic Materials Inventory (updated 2019)
Communication Disorders Materials in Kent Library (updated 2019)
Equipment Loan Agreement
Supply Request Form
 
 
 

Contact

Jayanti Ray
Interim Chair
Communication Disorders
Phone: (573) 651-2155
jray@semo.edu
Office: Grauel 112F

Center for Speech and Hearing
402 N. Pacific
Cape Girardeau, Missouri 63701