includes: record review
report of the evaluation documenting the idiosyncratic way a child learns;
specifying instruction according to strengths and weaknesses
hour-long feedback session reserved for parents and adult students
a deposit of $1500 is required to confirm and hold an appointment (not refundable)
the balance of $2700 is required on the day of the evaluation
For School Systems, this signed agreement will be held as a promissory note and a bill submitted with the completed report. Payment is due within 8 weeks.
Attendance at PPT/IEP meeting
Office or Phone Consultation
Non-testimony hearing preparation
If a child is sick on the scheduled evaluation date, the appointment will be rescheduled at the soonest available time.
Late arrival or rescheduling of feedback sessions will be billed for the extra time required.
Please read the policy and sign the agreement form, Signed forms are returned by email or to
the relevant testing address.
Billed Services are payable upon recipt of the bill. Overdue bills are referred to a collection agency and the costs of collection, including any legal fees, are added to the bill. A special 2 month courtesy is extended to school systems before imposing late fees of 3% monthly.
Default: Default is defined as a failure to remit payment amounts by due dates.
a) In the case of default, immediate payment will be demanded of the entire unpaid balance, including any interest, fees or late charges due, without prior notice.
b) I understand that if I default, my default may be disclosed to credit reporting agencies.
c) I understand that a late charge may be assessed.
d) I understand that in the case of default, my outstanding balance may be referred to a collecton agency or Dr. Cherkes-Julkowski may litigate to ensure payment. I agree to pay the cost of collection including, without limitation, interest, penalties, late charges, collection agency costs, court costs, and attorney fees. Collection costs can be up to 50 percent. This agreement to any and all delinquent amounts.
e) The forgoing are not the exclusive remedies of Dr. Cherkes-Julkowski
I have read, understand and agree to the terms set forth herein, including any necessary collection of defaulted amounts as described above.
Name______________________________________________________ Date _____________