Phone:
813.754.5555
Email:
info@headsusa.com
Fax:
813.754.5552
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School Permission Letter
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Is client attending school?
Yes
No
To Whom It May Concern,
attends your school. He/She is currently receiving therapeutic services from a contracted therapist with Healing Educational Alternatives for Deserving Students, LLC (HEADS). These services have been deemed appropriate and necessary in keeping with the mandate of the referral and the intention of the State of Florida. It is critical that you allow these clinical interventions to occur for this child so that this student may receive the support needed and reach his/her goals. The HEADS team will work in conjunction with you and your staff to be the least disruptive to the school day.
Below is the consent from the student’s legal guardian:
I hereby give my permission for HEADS staff/therapist to see my child,
at their school for the purpose of counseling/therapeutic intervention during the
School Year
Legal Guardian Signature
*
Legal Guardian Printed Name
*
Date
*
Date Format: MM slash DD slash YYYY
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Home
About us
Programs
Specialized Therapeutic Foster Care
Behavioral Health Therapy
Referral Form
Primary Care Physician Contact
Consent for Treatment
Confidential Info Consent
School Permission Letter
Behavior Checklist
Psychiatric Consent
Telehealth Consent
Confidential Info Release Consent
Day Program
Psychiatric Consent
Referral Form
Primary Care Physician Contact
Consent for Treatment
Confidential Info Consent
School Permission Letter
Behavior Checklist
Off Premises Consent
Confidential Info Release Consent
Handbooks
Client Handbook
Manual del Cliente
Telehealth
Telehealth Consent
Consentimiento De Telesalud
Extension
Disaster Plans
Careers
Contact us