This chapter outlines the importance of perceptual speech evaluation and how this assessment helps to determine the need for speech therapy, surgical intervention, or a combination of both. This chapter provides information on the components of the speech sample, speech sampling procedures, and approaches for rating speech characteristics commonly seen in patients with cleft palate and velopharyngeal dysfunction (VPD). The perceptual speech evaluation and oral examination are key components of the clinical assessment for suspected VPD and should be completed prior to velopharyngeal (VP) imaging. If VP imaging is needed, the perceptual evaluation will inform clinical decision-making regarding patient candidacy for imaging, as well as guide the selection of speech stimuli for use during imaging for valid results. Considerations for cross-linguistic speech evaluation are also discussed.