Informed Consent for Development and Behavioral Screenings In School

This public document acts as our "Terms of Service" when collecting sign up information and payment for individual school screenings. You agree to the terms below once Stripe Payment is completed.

Informed Consent for Occupational Therapy Screening

I hereby consent and authorize Arise Therapy Group, LLP (Arise) to administer an individualized screening service conducted by a licensed and registered Occupational Therapist to my child.
I acknowledge and agree that a parent or legal guardian does not need to be present for the screening session but is welcome to be present and observe.
I understand that all service payments are non refundable, are due at the time of service, and that this screening and/or ongoing services may not be covered by insurance.
I understand and am informed that, as in the practice of medicine, occupational therapy services may have some risks. I understand that I have the right to ask about these risks and have any questions answered about my child’s participation prior to screening.
I agree to hold Arise harmless for claims or damages in connection with the screening process.
This is a contract between myself and Arise, and I understand that it is also a release of potential liability.
I have carefully read and fully understand this Informed Consent Form and have had the opportunity to discuss it with a member of Arise if I chose.

BY ACCEPTING THE TERMS OF THIS AGREEMENT AND SUBMITTING PAYMENT via STRIPE, I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.