Release Of Information Name of Client Parent/Guardian Name give my consent to Sharone Gilbert, Psy.D., clinical psychologist, to discuss and review any school records or information pertaining to I understand that Dr. Gilbert may collaborate with other professionals to review and interpret results and that students under Dr. Gilbert’s supervision may be working with my child. Dr. Gilbert may consult with the following professionals: (Please Initial) School Personnel Pediatrician/Physician Supportive Service Providers Legal Representative Licensed psychologists Supervised Graduate students/fellows In addition, I give my consent for Sharone Gilbert, Psy.D, to observe my child, in his/her school setting.His/Her school setting Parent/Guardian (Digital Signature) Date MM slash DD slash YYYY Δ