Informed Consent for Speech Language Pathology Services (School year 2023-2024) Informed Consent for Speech Language Pathology Services (School year 2023-2024) Student Name*Parent Name*Please check the box beside the statement:* By signing below, I am consenting to participate in Speech Language Services (Classroom observation / Screening / Assessment and / or Therapy) offered by Magda Marais, Registered SLP of Sound Speech and Language Services Inc. I confirm that I understand the risks and benefits associated with speech and language services. I understand that my consent can be withdrawn in writing at any time to discontinue speech and language services. Thus, I, the parent/legal guardian of the above mentioned child, hereby request and consent to the SLP to see my child at Fort McMurray Montessori Group of Schools located at 190 Tamarack Way, Fort McMurray, Alberta. I further agree to and authorize the school staff to administer the SLP intervention plan as recommended by the SLP. The staff will help with treatment as needed under the direction and supervision of the qualified Speech-Language Pathologist. I understand that I have the right to ask about the benefits and risks and have any questions answered at any time, prior or during treatment. I have carefully read and fully understand this Informed Consent Form and know that I have opportunity to discuss it with the treating therapist Magda Marais in person or at cell number (780)881-6856. Signature of Legal Guardian*Date* Date Format: MM slash DD slash YYYY
