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New Client Packet

Please complete the following forms prior to your evaluation or first session at The Kids' Communication Center.

Page 6

THE KIDS’ COMMUNICATION CENTER, LLC

4906 Wisconsin Ave., NW

Washington DC 20016

202-486-7388

laura@thekidscommunicationcenter.com

CONSENT FOR SERVICES

                              , give my permission to The Kids’ Communication Center, LLC

to exchange information with the following physicians, programs, or other persons:

about 

, whose date of birth is

I also give permission for The Kids’ Communication Center, LLC to provide information, treatment, and consultative services to the above-mentioned client.

 

I understand that the fees for services provided are due upon receipt of the invoice.

.

Clicking Submit will take you to page 7.

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