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FEE FOR SERVICES AGREEMENT

 

     This is a contract for services agreement between Roger N. Meyer, D.B.A. "…of a different mind" and the party named below (hereafter referred to as the client) wherein Roger N. Meyer agrees to provide representation, advocacy and consulting and resource services.  Such services may include but shall not be limited to personal guidance, career advice, resource referral, and advocacy for the client and/or any minor child or legally dependent person, including direct representation--if allowed by law or administrative rules or regulations--before a civil or criminal court, administrative law judge, public or private agency employees and officials, employers, adult human service agencies, and other parties authorized by the client.

 

Both parties to this agreement are of the understanding that:

 

·         Roger N. Meyer will hold all information about the client and his/her family in strictest confidence.  Client lnitials______.

 

·         The client and will be regularly informed of contacts between Roger N. Meyer and the client's counselors, therapists, and/or other providers.  Client Initials______.

 

·         Roger N. Meyer is bound by the Standards and Code of Ethics of the American Counseling Association (ACA).  Client Initials_______.

 

·         Roger N. Meyer is obligated by Oregon Revised Statutes to report information regarding child, elder and mentally ill adult abuse to appropriate authorities of the State of Oregon.  Client Initials_________.

 

     It is the philosophy of Roger N. Meyer to work in cooperation with other service providers in an effort to establish positive working relationships on behalf of the client and his/her community support system.  "…of a different mind" operates under the principals of collaborative problem solving and management of misunderstandings in a non-adversarial manner.

 

·         Either party upon notification of the other may terminate this agreement.  Client initials_____.

 

     Provision of services by Roger N. Meyer shall be by fee-for-service (project by project) and/or by hourly rate as agreed upon prior to the signing of this contract.  Any modification of the terms of service shall be in writing and attached as addenda hereto.  Exceptional fee rates shall be agreed upon at the conclusion of the first hour of consultation.  Billing shall be monthly.  Absent other arrangements in writing, failure to pay constitutes cause for immediate termination of this agreement.

 

     For billing at hourly rates, "…of a different mind" has a tri-level fee structure.  Those rates are as follows:  (a) direct representation as advocate or client representative before others through face to face contact and/or attendance at agency meetings, hearings, or staffings:  base rate $80.00/hr; (b) administrative, travel and non-client-contact with other specialists and providers: base rate of $40.00/hr; and (c) client consultation on a one-to-one basis, base rate of $60.00/hr Consultation fees are generated at the conclusion of each visit.  Unusual document reproduction or access fees shall be billed at a direct-costs pass-through basis.  There is no charge for brief phone calls for "checking in" and scheduling.  Ceiling costs will be established and agreed to in advance for special projects (or by separate fee agreement in the instance of Social Security Representation) conducted under terms of hourly fees billing, or for primary billing based on fee for service work. While this contract remains in force, both parties hereby agree that disputes relating to expenses arising between the parties to this contract shall be resolved through mediation, or failing that, binding arbitration by a qualified person mutually selected by both parties.  Quality of service issues are not subject to mediation by a third party.

 

Terms of Contract:  ____________Hourly                 ____________Project by Project

                                                  Client Initials                                             Client Initials

 

 

____________________________Date_______   ______________________________

            ROGER N. MEYER                                                               CLIENT

 

 

I have received and read a copy of "Fee Structure and Billing Practices for Private Clients."        

 

            __________(Client Initials)

 

 

 

"…of a different mind"  18162 East Burnside, Portland, OR  97233

Phone and FAX:  503-6662776  Email:  rogernmeyer@earthlink.com

 

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