I have a teacher referral

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Subject: Speech Therapy Services Available at Your School

Dear Parents,

We are pleased to inform you that Erin Lucas, Clinical Director of Sound Savvy Speech Therapy, will be providing private speech services at your child's school. If your student has been recommended for speech and/or language development support, Erin is highly trained in diagnosing and treating childhood speech disorders.

To grant permission for Sound Savvy Speech Therapy to screen your child and share the results with you and the school team, please complete and submit the attached permission form.

Best regards,
Erin Lucas M.S., CCC-SLP

License #35337

Permission for Screening

By checking the box below, I consent to my child participating in a speech and language screening provided by Sound Savvy Speech Therapy. I understand that this screening is offered as a free service and that I will be notified of the results. *

Please complete the following:

Required

Child's Name: *

Parent Name: *

Parent Phone Number: *

E-mail Address: *

School Name: *

Teacher: *

Grade: *

Student's Date of Birth: *

Submit

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