Parental Consent for Compensatory Therapy School/Client Name* Student First Name* Student Last Name* Student Grade* Date* MM slash DD slash YYYY Number of SessionsI/we, parent/guardian(s) for the above named student, hereby grant permission to and authorize Hubbard & Tennyson to provide compensatory Speech Therapy services.Accept or Decline* Accept Teletherapy Accept In Person Decline Compensatory Services {Parent/Guardian(s) Sign Here}*(To sign this document enter your full name and press the "Sign" button.) Would you like to receive an email confirmation? Yes Email Address for Confirmation CAPTCHANumberPhoneThis field is for validation purposes and should be left unchanged.
