Services & Fees
Please complete and return to me prior to the start of evaluation
Parent consent is required to release any information or consult with other providers/professionals
Please have your child's primary teacher complete this form and send it back to me
Contains information about the rules and restrictions around protected health information (PHI).
This is a an acknowledgment of waiver of right to receive notice of HIPAA privacy policies.
This consent form will allow us to communicate information electronically.
This statement outlines ALAS' terms, conditions, risks and rules