or more parties. Thus, the nature of confidentiality in a forensic psychological evaluation is considerably different from the confidentiality provided by a treating or clinical psychologist. Notifications regarding this issue, including the likely recipients of the finished report, will be provided to all examinees prior to the initiation of any examination. I am a licensed psychologist. Like all psychologists, certain circumstances will require me to intervene for the safety of the examinee and/or others. In particular, if the examinee is a danger to him/herself or others, if is abuse of a child, developmentally disabled person, or vulnerable adult, I may be required to warn the person(s) in danger, and/or contact appropriate authorities. AGREEMENT Should you not feel comfortable with any of the terms above, please do not hesitate to contact me to discuss any of your concerns or the special circumstances of the assignment. Furthermore, please feel free to cross out, date and initial any items that do not apply to our working arrangement. My date of engagement in any matter is considered to be the date on which I was first contacted. Either party may terminate the expert-client relationship upon written notice (including email). Your signature below indicates that you have read this document, that you have understood its contents, that you agree to these terms, and accept responsibility for payment of fees. Please sign and date and return to me. You may also wish to keep a copy for your files. If you have made changes or amendments, I will sign the document and mail or fax a copy to you. A copy of this will also be provided to the examinee or their parent/guardian. Plaintiff 1 Name Date of Birth (DOB) Plaintiff 2 Name (if applicable) Date of (DOB) Plaintiff 3 Name (if applicable) Date of Birth (DOB) Attorney Name Signature Date Sarah M. Heavin, Ph.D. Date
or more parties. Thus, the nature of confidentiality in a forensic psychological evaluation is considerably different from the confidentiality provided by a treating or clinical psychologist. Notifications regarding this issue, including the likely recipients of the finished report, will be provided to all examinees prior to the initiation of any examination. I am a licensed psychologist. Like all psychologists, certain circumstances will require me to intervene for the safety of the examinee and/or others. In particular, if the examinee is a danger to him/herself or others, if is abuse of a child, developmentally disabled person, or vulnerable adult, I may be required to warn the person(s) in danger, and/or contact appropriate authorities. AGREEMENT Should you not feel comfortable with any of the terms above, please do not hesitate to contact me to discuss any of your concerns or the special circumstances of the assignment. Furthermore, please feel free to cross out, date and initial any items that do not apply to our working arrangement. My date of engagement in any matter is considered to be the date on which I was first contacted. Either party may terminate the expert-client relationship upon written notice (including email). Your signature below indicates that you have read this document, that you have understood its contents, that you agree to these terms, and accept responsibility for payment of fees. Please sign and date and return to me. You may also wish to keep a copy for your files. If you have made changes or amendments, I will sign the document and mail or fax a copy to you. A copy of this will also be provided to the examinee or their parent/guardian. Plaintiff 1 Name Date of Birth (DOB) Plaintiff 2 Name (if applicable) Date of (DOB) Plaintiff 3 Name (if applicable) Date of Birth (DOB) Attorney Name Signature Date Sarah M. Heavin, Ph.D. Date
Retainer-Agreement-2019.docx