Client Application

Welcome to the Ludden Speech and Language Clinic. Thank you for inquiring about our services. In order to submit an application, download the following items and mail them to:

Saint Xavier University
Ludden Speech and Language Clinic
3700 W. 103rd Street
Chicago, IL 60655

Please mail the following forms:

1. The following forms must be filled out completely. Be sure to include a description of speech and language difficulties.
   • 17 years and older
   • Adult Case History (PDF)
   • Adult Contact Information (PDF)
   • Adult Permission to Observe (PDF)
   • Adult Videotape Release (PDF)
   • 16 years and under
     • Child Case History (PDF)
     • Child Contact Information (PDF)
     • Child Permission to Observe (PDF)
     • Child Videotape Release (PDF)
2. A diagnostic request form so that an evaluation may be arranged at a mutually agreeable time.
   • Diagnostic Request Form (PDF)
3. A signed Ludden Speech and Language Clinic policies form.
   • Ludden Speech and Language Clinic Policies Form (PDF)

Once the Clinic receives your completed paperwork and there is an opening in the clinic schedule, you will be contacted to arrange a time for the evaluation. If you have any questions or concerns, please feel free to contact the Clinic at 773-298-3571.

We look forward to serving you and your family.

Gloria Banys
Coordinator, Ludden Speech and Language Clinic
Phone: 773-298-3571
Email: gbanys@sxu.edu