TWO-WAY CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

Specific Information to be released:
0 Unlimited disclosure
0 Hearing/ Audiological
0 Academic records
0 Psychoeducational evals.
0 Other

0 Vision testing/ reports
0 Social/ developmental history
0 EC records
0 Medical evaluations

0 Health evaluations
0 ADHD/ ADD reports
0 Speech/ Language testing
0 Current medications
PERMANENTLY RETAIN ORIGINAL SIGNED COPY WITH CLIENT EC FILES