Screening Authorization

Please correct the errors described below.

(the “Child”), hereby give a representative of The Loop Speech, Language, and Learning, LLC permission to evaluate the Child during a 15-minute speech/language/learning/occupational therapy screening. I understand that this screening is only a brief observation and although it is possible that speech, language, learning, or OT difficulties may be recognized during such an observation, a longer and more thorough evaluation is necessary to definitively diagnose such problems. Therefore, I agree that I will not hold The Loop Speech, Language, and Learning, LLC liable in the event a speech, language, learning, or OT difficulty is not recognized during this screening. I understand that recommendations will be made after this screening and the results of the screening will be discussed with me.

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