| In order to contract for services, the following Service Agreement is used. After the blanks are filled in by Dr. Berger, it is sent to the retaining party for a signature. |
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STEVEN H. BERGER,
M.D. Date goes here Re: Case Name goes here .. Thank you for referring your questions regarding the above named case to me for forensic psychiatric evaluation. I will be glad to offer my professional services regarding this case. Before I reserve time for this case, I ask that you send a retainer payment for the anticipated time that is to be devoted to this case. This retainer will not be construed as payment. Instead, it will be considered an escrow deposit to be applied to my final billing. In the event that time devoted to this case exceeds the retainer amount, I will bill you for further time. Payment will be expected promptly upon such additional billing. It is not my intention to distrust you. It is my intention to be compensated for my time. Insurance companies may pay after services are rendered, in response to my monthly bill, but only if payment is guaranteed by a letter, or by the attached contract, signed by an insurance company employee or attorney who has the authority to enter such agreements. Courts and governments may pay after services are rendered, in response to my monthly bill, but only if payment is guaranteed by (1) a court order specifying the hourly rate, (2) the attached contract signed by a person who has the authority to sign such contracts, or (3) a letter agreeing to the terms of the service agreement contract, signed by a person who has the authority to enter such agreements. My fee is $240.00 per 60 minute hour for reviewing records, performing examinations, preparing reports, conferring with attorneys, traveling time, testifying time, waiting time, or time spent in any other way on this specific case. Depositions are scheduled for a minimum of 2 hours. Court appearances are scheduled for either a half day (6 hours) or full day (12 hours). I recommend that you have me review all relevant medical records, depositions, investigation reports, police reports, photographs, and other helpful information prior to my examination of the examinee. In order to make most efficient use of my time, I suggest that you send all such records at least 2 weeks prior to the scheduled examination of the examinee. Retainer payment is expected 2 weeks before any appointment. If the retainer is not received when expected, the appointment will be automatically canceled. Full payment will be expected for appointments not kept, or for appointments not canceled 48 hours in advance. A charge may be made for deposition time, court time, or blocks of time longer than 2 hours, not canceled 2 weeks in advance. After you notify me that the case is closed, I will refund to you any unused retainer amount. Please sign the enclosed original service agreement for my services regarding this case, and return it along with the requested retainer amount. If the signed service contract and retainer are not returned 2 weeks from the date of this letter, then my involvement in this case will stop, and my name may not be listed by you as a witness. Thank you for allowing me to contract with you in this way. Please contact me any time you have questions or further information. Sincerely yours, Steven H. Berger,
M.D.
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STEVEN H. BERGER,
M.D. SERVICE AGREEMENT (Attorney's name and address goes here) Date goes here Re: Case Name goes here .. As per your request, time has been reserved regarding the above-named case for: ______Review of records, estimated ______ hours. ______Evaluation of examinee scheduled for____________ ___________________________________________ ______Preparation of report, estimated ______ hours. ______Deposition
(2 hours minimum time reserved) ______Court appearance on ____________________________ ______Conference
with attorney by phone or in person, travel time, other time devoted
specifically to this case, estimated ______ hours. Please sign below, indicating your acceptance of this service agreement and the contractual provisions contained in this accompanying cover letter. Please keep a photocopy of this service agreement for your records, and return these pages to me with your retainer payment of: $____________________. Thank you for allowing me to arrange for provision of my services to you in this way. Sincerely yours, Steven H. Berger,
M.D. Contract accepted by: _________________________________________________ _________________________________________________ Date:___________________________
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