Observer Application

It is the policy of Cheshire Speech and Voice Center, Inc. (Cheshire Center) to maintain strict privacy with information released to and shared with our staff for client files and in-house discussions. As professionals, we respect the privacy of our clients and families and strive to create trust with clients, families, and other agencies we serve.

I recognize and acknowledge that I will, during my association with Cheshire Center, be privy to confidential, proprietary, and non-public information including, but not limited to, information and records of Cheshire Center clients and business practices, as well as developments and devices used in providing therapy services.

I agree that I will hold confidential all such information and will not, either during my time at Cheshire Center or at any time thereafter, either directly or indirectly use for my own benefit or divulge the confidential information to any person or other entity.

Additionally, during my association with Cheshire Center and for a period of one (1) year thereafter, and upon request of Cheshire Center, I will sign any additional documents reasonable and necessary to give effect to any secrecy or other agreements relating to confidential information between Cheshire Center and any other party. and any other party.

I have received a copy of, read, understand, and agree to uphold this written policy on matters of confidential information. I also understand that in my daily job duties, I will have free access to confidential clinic operations and any violation of confidentiality, in whole or in part, could result in disciplinary action and/or legal action. I recognize that this signed document of my agreement to uphold the provisions of this policy will be kept on file at the Cheshire Center.