Contract for Evaluation of Services
For Admin Use Only
Responsible Party
Client Name
Client Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Dr. Hobson conducts evaluations and has agreed to conduct a:
Comprehensive Diagnostic Evaluation (CDE)
Psychoeducational Evaluation (PEE)
Independent Educational Evaluation (IEE)
All services date required by Dr. Hobson will be completed by:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hourly Rate Agreed Upon:
Hourly rate not to exceed:
Deposit Amount
Submit
Should be Empty: