Consent for Exchange of Information

This form provides parental permission for the exchange of relevant health, development and/or educational information between a Child Care Health Consultant (CCHC), the child care program staff and other individuals, programs or agencies that are working with the child and family in an effort to better understand and address their needs. This form is for use in situations where there is not a referral to services.

This form was developed through a collaboration between Abby J. Cohen, J.D. and CCHP.