Consent Form

Consent to be Photographed, Audiotaped, and/or Videotaped

In order to provide excellent care, track progress, and assist in parent training, All About Speech, Inc. may photograph, audio tape and/or video tape evaluation and treatment sessions to be used solely for instructional, educational and diagnosis purposes.

I am either signing for myself or have legal guardianship for the individual listed below and I agree to allow the named individual to be photographed, audiotaped, and/or videotaped as part of the evaluation and treatment sessions. I understand that All About Speech Inc. will not use the recordings outside of the clinic without further written consent by me.

Consent Form
Type your name here again to sign the form