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Type of consultation
Type of problem
File Name :
I authorize the Speech and Language Pathologist to perform all required tests, examination and treatment procedures to complete their service mandate I also authorize the Speech and Language Pathologist to use my email address to open my cient account on this cient portal, a SSL certificate secured documentation exchange internet tool accessed only with username and password
Teaching and Research (optional):
I authorize the Speech and Language Pathologist to use speech. language, voice or academic skills information, as well as aucio or video record rigs. collected during assessment and treatment. for teaching or research puposes.
Would you like us to inform another professional (medical doctor, specialist. school personnel. etc) about our assessment results and recommendations? Please indicate above the name of the professional and how to reach them. This request also is a consent to exchange information with mentioned professional.
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