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  • TLC - Outside Provider Release Form

    Please complete this form before visiting our clinic. Thank you!
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  •  Terms & Conditions

    If visiting Therapeutic Learning Center for observation or as an outside provider, I AGREE THAT: 

    1.     I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors, or personnel, and not seek to obtain confidential information from a client or any staff.

    2.     My services are donated to Therapeutic Learning Center without contemplation of compensation or future employment, and given with humanitarian or charitable reasons.

    3.     I shall not sell or attempt to sell goods or services, request contributions, or to solicit persons to sign or distribute political petitions on clinic premises. 

    4.     I shall be punctual and conscientious, conduct myself with dignity, courtesy, and consideration of others, and endeavor to make my work professional in quality.

    5.     I shall attempt to resolve any problems related to my activities with my supervisor immediately.

    6.     I shall make my best effort to fulfill my commitment to the clinic by completing all assignments that I accept. 

    7.     I shall at all times uphold the philosophy and standards of the clinic and obey all clinic regulations, rules and policies as explained to me by my supervisor.

    8.     I understand that Therapeutic Learning Center reserves the right to terminate my observation/outside provider status as a result of (a) failure to comply with the clinic policies, rules, and regulations; (b) absences without prior notification; (c) unsatisfactory attitude, work or appearance: or (d) any other circumstances which, in the judgment of the supervisor, would make my continued service at TLC contrary to the best interests of the clinic.

    I have read and understood each of the above conditions and I agree to be bound by them.

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