Steven H Berger, MD Forensic Psychiatry
Steven H Berger, MD Forensic Psychiatry

Inquiries are welcome ONLY from attorneys, courts, insurance companies, or employers.

 

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.

 

STEVEN H. BERGER, M.D

PO Box 44106

Indianapolis IN 46244
Phone 317-929-1485
Fax
317-929-1485
Email shbergermd@yahoo.com
Website www.bergerforensic.com

..

& (Attorney's name and address go here)

 

Date:    &goes here

 

Re:       &Case Name goes here

 

Dear Attorney &’s name goes here:

 

Thank you for referring your questions regarding the above named case to me for forensic psychiatry evaluation. I will be glad to render 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 to be devoted to this case. This retainer is not full payment. Instead, it is an escrow deposit to be applied to my bill. In the event that time devoted to this case will exceed the initial retainer amount, I will bill you for additional retainer. Payment will be expected at that time. My intention is not to distrust you. My intention is to be paid for my time.

 

(Insurance companies may send payment after services are rendered, in response to my monthly bill, but only if payment is guaranteed by a letter or the attached contract. The letter or contract must be signed by an insurance company employee or attorney who has the authority to bind the insurance company.)

 

(Courts and governments may send payment 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 bind the government, or (3) a letter agreeing to the terms of the service agreement contract, signed by a person who has the authority to bind the government.)

 

My fee is $300.00 per 60 minute hour for reviewing records, performing examinations, preparing reports, conferring with attorneys, travel 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 a half day (6 hours) or full day (12 hours).

 

Retainer payment is expected 2 weeks before any scheduled event. If the retainer is not received when expected, the appointment will be automatically cancelled. Full payment will be charged for appointments not kept, or not cancelled 48 hours in advance. Blocks of time longer than 2 hours may incur a charge if not cancelled 2 weeks in advance. The retainer covering the first 2 hours of service is not refundable. After you notify me that the case is closed, I will refund to you any remaining retainer amount.

 

It is your responsibility to send me all relevant medical reports, depositions, investigation 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 a scheduled examination.

 

Please sign the attached service agreement for my services regarding this case, and return it along with the initial 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,

 

& (faxed directly from computer)

 

Steven H. Berger, M.D.

Board Certified in General Psychiatry and Forensic Psychiatry

Volunteer Clinical Assistant Professor of Psychiatry, Indiana University School of Medicine

 

Last revised 11-1-17

 

 ...........

 

Service Agreement

 

STEVEN H. BERGER, M.D

PO Box 44106
Indianapolis IN 46244
Phone
317-929-1485
Fax 317-929-1485
Email shbergermd@yahoo.com
Website www.bergerforensic.com

 

&(Attorney's name and address go here)

 

Date     &goes here

 

Re:      &Case Name goes here

.

Dear Attorney &’s 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)

 

     scheduled for __________________________________

 

     location _______________________________________

 

______Court appearance on ____________________________

 

 

__&____Conference with attorney by phone or in person, travel time, or other time devoted specifically to this case, estimated __&____ hours.

 

______Other:___________________________________________

 

 

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 2 pages to me with your retainer payment of:

 

$_&_____.

 

Thank you contracting for my services to you in this way.

 

Sincerely yours,

 

& (Faxed directly from computer)

 

Steven H. Berger, M.D.

Board Certified in General Psychiatry and Forensic Psychiatry

Volunteer Clinical Assistant Professor of Psychiatry, Indiana University School of Medicine

 

Contract accepted by:

 

         _________________________________________________

 

         _________________________________________________

        

         Date:___________________________

 

Last revised 11-1-17

 

 

Steven H Berger, MD

PO Box 44106

Indianapolis IN 46244

317-929-1485

shbergermd@yahoo.com

 

Print Print | Sitemap
© Steven H Berger, MD