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Please review and complete the following form:

Informed Consent for Cognitive Assessment 

I authorize and request that a licensed educational psychologist under Little Seed Education Consulting administer a standardized test of general intellectual ability to my child for whom I am legally responsible. Please enter your child's formal name, Date of Birth (month/date/year), age (as of today), and gender. 

Gender

By initializing each item below, I indicate that I have read it carefulIy and understand the extent of the service offered and policies.

3. I understand there is a flat fee for IQ testing and there will be an extra fee incurred for a 20 minute virtual follow up session to review test results. Please indicate the option you want below.
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©  Little Seed Education Consulting 

flai@littleseedpsych.com
650-285-3365

21801 Stevens Creek Blvd #207

Cupertino, CA 95014

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