Release Of Information

  • 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.
  • In addition, I give my consent for Sharone Gilbert, Psy.D, to observe my child, in his/her school setting.
  • Date Format: MM slash DD slash YYYY