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	Fax-back to: ½ YEAR CHECKLIST Parent Consent I hereby authorize _______________________________ (name of referring agency) to complete and release this Speech/Language Checklist to the Preschool Speech-L Add to Reading List Document Date: 2014-09-15 10:30:12 Open Document File Size: 154,41 KB Share Result on Facebook

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Fax-back to: ½ YEAR CHECKLIST Parent Consent I hereby authorize _______________________________ (name of referring agency) to complete and release this Speech/Language Checklist to the Preschool Speech-LAdd to Reading List