Release of Information

This form is used for to authorize the release of information including, educational, assessment, and therapy documentation, as well as verbal communication regarding your child.  This information is to be used for diagnostic and treatment planning purposes only.   Please download and fill in the appropriate information.  You may fax or deliver the completed form to our office for processing. 

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Let's Talk Authorization to Release Information 2013.doc85 KB

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Our son Matthew is 13 years old and has been receiving Speech and Occupational Therapy at Let's Talk since May of 2007.

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