EFTA00306963.pdf

James Lawrence Thomas,.. Clinical Psychologist & Neuropsychologist 19 West 34th Street, Penthouse New York, New York 10001 Cognitive Remediation Assessment Neurofeedback Psychotherapy Lesley Jee To whom it may concern, Faculty, NYU Medical Center April 6, 2014 re: Neuropsychological Evaluation This is a letter of agreement for me doing a Neuropsychological Evaluation will from)'. Your deposit of $1000 reserves the appointment for April 12th, from 9:00am to 5 pm. The total fee will depend on the number of hours spent on this case, at the rate of $225 per hour. Testing is usually about 8 hours, if we are efficient. Scoring the tests and writing the report is another 7 hours. The balance is due April 12th, which is estimated at (15 hours x $225= $2375 + $500= @2875). A fee of $500 is being added for arran ing with another colleague in order to complete the testing in one day. Please arrange to have e on time, and have her bring food for a very short break. I will assume that you are agreeing to the following terms: There is no guarantee that the scores will result in a certain diagnosis. Full payment is due at the last testing session. Lateness to any appointments will be charged extra at a rate of $225 per hour; calling in sick less than 48 hours before an appointment will result in a $250 charge. More than 8 hours of testing will be charged at the usual rate, $225/hour. Extra testing is sometimes recommended in order to make clarify the diagnostic picture. Additional writing or consultation after the final report is done is at the rate of $200 per hour. Aside from typos and historical corrections, reports are considered final. Clerical work by my assistant after the report is completed will be at a rate of $50 per hour, minimum 1 hour charge. You will be given 1 copy of the report; please make extra copies for your records and possible future use. These extra charges will not be necessary if you plan carefully and get me all the materials on time. I am assuming this is not a forensic case; if and when this becomes a forensic case, a higher hourly rate will come into effect. The report produced under this agreement will likely satisfy the requirements of getting accommodations for school and standardized exams, such as the SAT, GRE, LSAT, MCAT and similar exams. You need to supply me with background documentation and history. The report will be completed about 2 weeks after the final testing date and after all documentation is received. This includes a medical and developmental history. E mail me or mail any information not included in the history form given to . Reports are not released until complete payment is made. By giving me the deposit I am assuming you are agreeing to the above terms. I will not proceed without this signed agreement by the responsible person. Sincerely, EFTA00306963 James Lawrence Thomas, PhD Sign here Neuropsychologist EFTA00306964