about-aspenpediatricspeechAspen Pediatric Speech Language Services

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SPEECH LANGUAGE PATHOLOGY

COMMUNICATION GROUP CONSENT FORM

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Child's Full Name

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Background Information

My child's first language is:

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Consent:

I give consent for my child to participate in a communication group with Michelle Thompson, Speech-Language Pathologist. I give consent for session notes and clinical reports to be shared with my child’s classroom teacher(s) and administrators.

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SPEECH LANGUAGE PATHOLOGY

COMMUNICATION GROUP CONSENT FORM

"How one handles success or failure is determined by their early childhood."

~ Harold Ramis