I authorize the staff of Central Texas Therapy Spot, PLLC to: 

1. Administer and perform those treatments that have been prescribed by my/my childʼs physician. 
2. Release pertinent medical information to my/my childʼs physician, referring agency, or insurer and others as may be required. 
3. Request and obtain medical information from my/my childʼs physician and other health care professionals as necessary to provide quality therapy services.

I authorize the therapists of Central Texas Therapy Spot, PLLC to provide speech therapy services to my child at the following locations;