Emily Hathaway, M.S. CCC-SLP & Associates
Certified, Licensed Speech-Language Pathologists
6905 NW 122nd Street OKC OK 73142
Phone: (405) 603-6622
Fax: (405) 722-3244
I give my permission for my child to have photographic and/or video images taken while at the offices of Speech Pathway or on a Speech Pathway sponsored activity for the following purposes:
By signing this document, I hereby waive any rights of compensation or ownership thereto of all photos/videos. Further, by signing below I understand that the office of Speech Pathway LLC. records video surveillance to ensure the safety of our staff, families, and patients.