• Consent to Evaluate

    I hereby consent to the following evaluation for my child for the purpose of determining eligibility for services in the Early Intervention Program.
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  • In order to complete the evaluation packet, the enclosed Health Form must be completed by your pediatrician and given to the evaluators on the day of the evaluation.  If it will be difficult for you to have the form completed, you may sign the following consent so we may contact the pediatrician directly.  However, we do request that if at all possible, you have the health form at the time of the evaluation.

    I hereby consent for Little Angels Center, Inc to assess my child’s immunization record and current health status for the purpose of completing a developmental evaluation.

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