PARENT CONTRACT FOR SPEECH SESSIONS:

This document serves as an agreement between Wissam Chidiak, Speech and Language Pathologist, and the parent or legal guardian, regarding speech therapy services.

The parent or legal guardian, whose name will be provided at the end of this form, and Wissam Chidiak agree to the terms set forth.

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Notification of Legal and Privacy Policies:


Privacy Policy

- Speech therapy services are provided at the American International School Lagos (AISL) campus by Wissam Chidiak, Speech and Language Pathologist.

- All client information will be kept confidential. It will be kept in a secure location away from public access, and only the SLP, the school and the parents will have direct access to it without written approval.

- Evaluation reports, progress reports, therapy goals and therapy plans will be exclusively communicated with the school and the parents.

- Evaluation reports, progress reports, therapy goals and therapy plans may only be provided to outside sources, such as doctors or insurance providers, upon written request by the parents.

- To ensure your child’s safety during therapy, a CCTV is installed in the therapy room. However, the video footage is only retained for a limited period and securely stored away from public view.

- No promises outside of the agreement made on or before the effective date will be binding upon the parties.


Cancellations

- If your child is sick or an emergency emerges, please contact the SLP, as we are understanding of unexpected situations

- If we are unable to keep a therapy appointment for any reason, we will notify you as soon as possible, and arrange to schedule an in-person or an online make-up appointment.


Sessions

⁃ We can conduct an initial evaluation at the parents’ request. Alternatively, parents can provide their child’s previous private practice evaluation report to obtain an updated assessment of the child’s abilities. If the evaluation report is outdated, an updated evaluation is necessary to establish goals and provide therapy.

- Speech-Language therapy services will be provided based on goals agreed upon by both parties in order to best serve your individual child. Goals can be established through one of more of the following means: administered evaluations/reports, outside evaluations/reports, observations and parent requests.

- Therapy sessions will be 30 minutes. Sessions scheduling will depend on your child’s classroom schedule.

- In-person therapy sessions are only available on campus during school hours when classes are in session. If you’re interested in therapy sessions outside of these hours, such as during holidays, weekends, or while traveling, please discuss the possibility of online sessions or alternative locations outside the AISL campus with the SLP.


Financial Policy


Evaluations Tariffs:

- Rate of articulation assessment, including report: 80.00 USD

- Rate of written language assessment, including report: 150.00 USD

- Rate of expressive and receptive language assessment, including report: 150.00 USD

- Rate of expressive and receptive language with an articulation assessment, including report: 200.00 USD

- Rate of ADOS-2 assessment, including report: 250.00 USD


Sessions Tariffs:

- Rate of speech-language therapy 30 minutes individual sessions: 40.00 USD

⁃ Rate of Parental Guidance 30 minutes sessions: 40.00 USD


Means of Payment:

- Payment can be settled in either NGN or USD and can be made in cash, via bank transfer, or by online payment (debit/credit card).

- Upon receipt of payment, the Speech and Language Therapist will provide a receipt within a few days for the services rendered.

- Please note that parents are responsible for submitting all claims and receipts to their insurance company if they wish to seek reimbursement for speech therapy services.

- These rates for evaluation and/or therapy are applicable for the current scholastic year.


I have read, understood, and agree to the policies outlined above. By submitting this form, I consent to all rules and regulations stated.

Parent's Name:
*
My Child's Name: *
Date: *
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