Registration Form – Speech + Language Virtual Consult

Please complete these two forms below as part of your registration. Part One is the Registration Form. Part Two is the Liability Release Statement.

Please click SEND for Part One before moving onto Part Two. They are two separate forms.

*Please click SEND before moving onto Part Two* 

Liability Release Statement

Anytime that you are concerned about your baby or notice symptoms, call your pediatrician’s office. This consult is designed to provide information on the care of babies and toddlers. It is intended as reference material only, not as a medical manual. This consult is done with the knowledge that Infant Basics and Toddler Training, LLC or Sprouting Speech, LLC specifically disclaim all responsibility for any liability, loss, or risk-personal or otherwise-to any parent, person, or entity with respect to any illness, disability, injury, loss, or damage to be caused, or alleged to be caused, directly or indirectly, by the use or application of any of the contents of this consultation.

This consultation does not take the place of your pediatrician’s visits or recommendations. This consultation is used as a supplement to your pediatrician’s recommendations. Use the information obtained as a guide for your own parenting choices.