Consent For Services
Child's Date of Birth
Please Select One Option Below
Type a question
I authorize Cobb Speech and Language Services to render appropriate evaluation and therapy services to the client named below in accordance with state and federal laws. I understand that care will be provided by a qualified, licensed, and trained health professional. I recognize, agree and understand that I have the right to refuse treatment or terminate services at any time by Cobb Speech and Language Services in writing. In addition, Cobb Speech and Language Services may terminate services by notifying me in writing.
I do not give my consent or am withdrawing my consent regarding Cobb Speech and Language Services rendering evaluation and therapy services to the client named below.
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