TERMS

CONTRACT FOR SPEECH LANGUAGE PATHOLOGY SERVICES

This contract is between ______________________ (the “Parents/Guardians”) and Smart therapy center. In consideration of the mutual promises contained within this contract, the Parents/Guardians and STC agree to the following:

1. The STC will provide speech language pathology services to ________________, the child of the Parents/Guardians (the “Child”). These services are to include one or more of the following:

(a) screening of speech and language skills;

(b) assessment of speech and language skills;

(c) intervention for speech and/or language disorders and/or delays;

(d) preparation of screening, assessment, progress and discharge reports as requested;

(e) participation in team meetings with family and other professionals as required;

(f) consultation with the Parents/Guardians and others involved;

(g) preparation and delivery of referrals to other professionals as deemed appropriate by the Parents/

Guardians and the SLP;

(h) selection and implementation of augmentative and alternative communication devices; and

(i) preparation of home programs, as requested.

2. The rate charged by STC to the Parents/Guardians for the above services will be $35.00 an hour, or

$25 per 45 minutes.

3. STC will charge the Parents/Guardians for the preparation of written reports as per the fee schedule.

Reports are written following an assessment and/or upon request.

4. Where an appointment for the delivery of the Services is canceled by the Parents/Guardians, they will

pay the STC:

(a) $0.00 if the cancellation occurs more than 10:00 Am hours before the scheduled appointment or any emergency;

(b) 50% of the scheduled payment if the cancellation occurs 1-2 hours before the scheduled appointment.

5. Where the Child fails to attend a scheduled appointment and that appointment has not been previously canceled by the Parents/Guardians, they will pay STC 100% of their scheduled payment.

The parties have executed this Agreement in Amman, Jordan on _______________, 20______.

_____________________________________ _______________________________

 PARENT/GUARDIAN PARENT/GUARDIAN

Address :

 

Phone: