By my signature below I verify that I am the parent and/or legal guardian of the child named above and have the legal authority to seek mental health and counseling services for him/her.  I hereby grant Neema Counseling PLLC and any counselor affiliated with this entity permission to provide these services for my child. I further understand that according to Texas law both parents have equal access to all medical and mental health records of a minor child, unless specifically prohibited by law. Therefore, all medical and mental health records will be released upon request to a legal parent, guardian, or authorized representative of this minor child. I understand that Neema Counseling PLLC does not provide a forensic evaluation. I understand that Neema Counseling PLLC does not make recommendations about placement of a child for custody disputes and does not provide investigation or reassessment to reach a determination about child abuse or custody.