[FORM 17—Use the top of this page for your letterhead.]Consent and Agreement for Psychological Testing and EvaluationI,,agree to allow the psychologist named below to perform the following services:qPsychological testing, assessment, or evaluationqReport writingqConsultation with school personnelqConsultation with lawyersqDeposition (that is, written or oral testimony given to a court, but not made in open court)qTestimony in courtqOther (describe):This agreement concernsqmyself orqI understand that these services may include direct, face-to-face contact, interviewing, or testing. They may alsoinclude the psychologist’s time required for the reading of records, consultations with other psychologists and profes-sionals, scoring of tests, interpreting the results, and any other activities to support these services. If I have questions orconcerns about this assessment, the evaluator agrees to be available to discuss these after completion of the testing andinterview.
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