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Form17 - [FORM 17-Use the top of this page for your...

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[ FORM 17 —Use the top of this page for your letterhead.] Consent and Agreement for Psychological Testing and Evaluation I, ,agree to allow the psychologist named below to perform the following services: q Psychological testing, assessment, or evaluation q Report writing q Consultation with school personnel q Consultation with lawyers q Deposition (that is, written or oral testimony given to a court, but not made in open court) q Testimony in court q Other (describe): This agreement concerns q myself or q I understand that these services may include direct, face-to-face contact, interviewing, or testing. They may also include 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 or concerns about this assessment, the evaluator agrees to be available to discuss these after completion of the testing and interview.
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