Please read: Therapy & Wellness Connection Policies & Procedures Then fill out the following Consent to Therapy Services Form: Therapy & Wellness Connection Policies & Consent to Therapy Services Therapy & Wellness Connection Policies* I have read and been given a copy of Therapy and Wellness Connection policies.Therapy & Wellness Connection Policies* The policies have been explained to me by a therapist at Therapy and Wellness Connection.Client Rights* Therapy and Wellness Connection has explained to me my rights as a client. I am aware that there is a copy in the office that I can see at any time or I may request my own copy.I consent for treatment in the following areas:* Speech therapy Occupational therapy ABA/Behavior therapy Physical therapy Intervention services Music therapy Tutor services Check all that apply.Parent/Guardian Electronic Signature* First Middle Last Today's Date* MM slash DD slash YYYY Client CommunicationConsent* I give my consent for communication regarding client information, appointment times, or any necessary update via all electronic devices (cell phone, fax, email). All communication must be Monday through Friday between the hours of 8 a.m. to 5 p.m.Parent/Guardian Electronic Signature* First Middle Last Coordination of Care* I accept coordination of care. Δ
