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Consent for Observation
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I hereby grant Branched Out Therapy, Inc., and their consultants, contractors or employees to observe in the following setting(s):
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For the purpose of:
I understand that during this observation, Branched Out Therapy, Inc., their consultants, their contractors, or their employees may speak to providers, clinicians, teachers, employers, etc. about the client and I thereby grant permission for such discussions.
I am the client, parent or legal guardian of the person named below and have the legal authority to provide consent for observation.
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