Common Contracts
1 similar Therapy Contract contracts
THERAPY CONTRACT, POLICIES & FINANCIAL AGREEMENTTherapy Contract • August 12th, 2018
I, , hereby give my full consent for my child, , or myself, to receive speech and language therapy and treatment provided by Lori A. Gross, Speech and Language Pathol- ogist, until I notify Ms. Gross of any changes or until Ms. Gross determines that services are no longer necessary. If I am referring my child for services, I certify that I have legal responsibility for this child and am authorized to seek treatment for him or her.
