Consent Form for AI Assistant - Speech Therapy Services, P.C.

AI Assistant Consent Form

Parent/Guardian Name

Child's Name

I, the undersigned parent/guardian, hereby giver my consent for Speech Therapy Services, P.C. to utilize an AI assistant for the purpose of creating daily notes and evaluations from audio-recorded therapy sessions involving my child. I understand that the AI assistant will process the audio recordings to generate summaries, insights, and therapeutic notes that will assist in documenting my child's progress and treatment.

To streamline the documentation process. To enhance the quality of therapeutic notes and evaluations. To provide personalized insights based on recorded sessions.

I understand that Speech Therapy Services, P.C. will take all necessary precautions to ensure that my child's privacy and confidentiality are protected. All audio recordings and generated documents will be stored securely and accessible only to authorized personnel.

I acknowledge that I have the right to withdraw my consent at any time in writing. Should I decide to withdraw my consent, I understand that it will not affect my child's access to speech therapy services. By signing this consent form, I confirm that I have read and understood the information provided. I voluntarily agree to the utilization of the AI assistant as outlined above.

Parent/Guardian Signature:

Date