Graduate Student Consent Form

Wee Speech, P.C.

8707 Skokie Blvd. Ste. 402 Skokie, IL 60077 (847) 329-8226
Child's Name

First NameLast Name
Consent for Graduate Student Direct Service

Wee Speech, P.C. provides second year graduate students in speech and language pathology, the opportunity to gain clinical experience within our setting. We feel strongly that providing this opportunity to our rising speech and language pathologists can be mutually beneficial. While in our clinic, the students are fully supported and supervised while providing speech and language services to your child. As usual, your child's therapist will remain present and engaged in each session.
Consent for Student Observers

Wee Speech, P.C. provides students in speech and language pathology the opportunity to observe therapy sessions within our setting. These students are showing a strong interest in the field of speech pathology, therefore, we are providing them opportunities to observe our skilled team.
I am aware that I can revoke my consent in writing at any time for any reason.
Parent/Guardian Signature
Parent/Guardian Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Wee Speech, P.C.