Permission to Video for Educational Use

Patient Information
Patient Name*
First Middle Last
Patient Date of Birth*
MM slash DD slash YYYY
Legal Guardian*
Email*
Consent for Video and Pictures
Permission to Video for Educational Use
As part of the assessment and therapy process, it is often helpful to take pictures and/or video recordings of children while working with them. With video recording, we are able to review performance, critique therapy practices to make them more effective for each client, and compare performance at different times during therapy to show growth. We can also use video recording to educate and train other speech therapists or students in speech pathology. Photos are important as data collection and to be able to send home quick images of your child completing therapy tasks or communicating something new.
Hidden
Hidden
Hidden
Consent*
- I have read and agree to the Permission to Video for Educational Use Policy above.
Hidden
Untitled
Comments
This field is for validation purposes and should be left unchanged.

Patient Information