1. Informed Consent & System Disclosure

Purpose of Information Collection: I understand that the information I provide will be used for clinical assessment and personalized intervention. Audio Recording and Analysis: I understand that speech samples may be collected and analyzed using AI-assisted tools to support clinical decision-making. Use of AI Technology: I know that AI is used to analyze my speech. It helps my therapist, but it does not replace my therapist’s judgment. Language Limitation: I understand that the current model is primarily trained for English and may not be fully accurate for other languages or dialects. Confidentiality and Data Protection: I understand that all info and recordings will be handled confidentially and stored securely. Final Declaration: I confirm I have read and understood the above information and voluntarily agree to proceed.

2. Patient Identification & Demographics

3. Contact & Emergency Information

2.4 Address

2.6 Emergency Contact

Permission to Contact: I authorize the clinic to contact the above emergency person if necessary for health or safety reasons.

4. Respondent & Caregiver Information

5. Referral, Funding & Administrative Data

6. Medical & Diagnostic History

7. Living, Education & Occupational Profile

8. Speech Profile