Speech and Language Therapy Agreement


Speech and Language Therapy Agreement – to be read and signed by parent or legal guardian

I understand and agree that;

  1. I am fully responsible for my child’s physical, mental and emotional well-being. 
  2. Speech and Language Therapy sessions are delivered in-person in Bath or online via Zoom or Teams.
  3. sessions last up to 60mins which includes the writing up of 'take home messages' at the end of each session.
  4. The frequency of sessions is determined on a case-by-case basis.
  5. Sessions can take place at home, pre-school, nursery, school or in a suitable community space. There may be an additional charge if room hire is required.
  6. Travel costs are charged at a mileage cost of 45p per mile. These will be agreed ahead of your appointment.
  7. A parent/carer/practitioner will always be present during sessions.
  8. Information will be held as confidential unless agreed otherwise, in writing, except as required by law.
  9. MITOS store and process information in line with GDPR policy.
  10. MITOS may liaise with multidisciplinary teams involved in a client’s care. Observations, targets and reports will only be shared with parental consent. Any concerns should be discussed with the MITOS practitioner.
  11. MITOS practitioners may, when consent is given, use video/audio to record sessions for assessment, as part of therapy or for training purposes. When used for training purposes access is limited to MITOS.
  12. I am to inform MITOS if, for any reason, my child cannot attend sessions. If less than two weeks notice is given, I will still be charged for room hire. If less than 24 hours notice is given I will still be charged for the session and room hire. A replacement session may be offered at the discretion of the MITOS practitioner. 
  13. If the MITOS practitioner needs to cancel a session will be offered as soon as possible.
  14. Terminating sessions requires no less than 4 weeks notice.
  15. It is my responsibility, as the client’s parent/guardian, to inform MITOS in writing in the event that I wish to terminate sessions. At this point in line with GDPR, MITOS will remove my personal contact information from records and the onus will be on me to resume contact should the need arise.
  16. I am aware of the MITOS Safeguarding and Privacy Policies, including data protection. 

To confirm you agree, please complete this form.