FEE AGREEMENT AND PSYCHOLOGICAL SERVICES CONTRACT 2026

1. Click ‘Get Form’ to open the FEE AGREEMENT AND PSYCHOLOGICAL SERVICES CONTRACT in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. This information is crucial for identifying the individual receiving services.
3. Fill out the home address and reason for referral sections. Be specific about the referral reason to ensure appropriate services are provided.
4. In the Family section, provide details about parents' names, dates of birth, and employment. Include any step-parents if applicable.
5. Indicate whether there is a divorce or legal separation, and provide custody documentation if necessary. This helps clarify family dynamics.
6. Complete the Education section by entering your child's school information, including any special education needs like a 504 Plan or IEP.
7. In Physical Health, list current health concerns and your child's physician's contact details. This ensures comprehensive care.
8. Finally, review all entered information for accuracy before saving or sending your completed form through our platform.

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