INFORMED CONSENT & RETAINER AGREEMENT
FOR ADOPTION
By signing this form, I am stating that I have read and understand the purpose of the evaluation. I understand that a report will be completed in the best interest of my/the child/children and such findings will be shared with me upon its completion in an effort as unite and provide direction to families as they are going through an adoption. It is hoped that the observations, evaluations, and recommendations help promote forward movement of the current adoptive process.
Base Fees for Social Study
The base fee for this service is $ 1,000.00for the pre-placement and the post-placementcombined adoption report. I understand if the child is already living in the home this will only necessitate 1 report. Fees in total due are $1,000.00before your appointment will be reserved. This amount includes expedited fees. Thisfee covers 2-3 hours of interview time, one 15-minute client requested phone conferences, collateral source contact, reviewing reference letters, and any other requested documentation for both parties. Those submitting content in excess of what could be held in a ½ inch binder will be charged additional fees to review, as well as those requiring additional reports or home visits. In the rare event that I spend significantly more time than anticipated, I will inform you of other charges. Extra fees apply to those parties residing out of the DFW Metroplexas well as for those requiring EXPEDITED or services and are not included in the above total.
Settlement Prior to Conclusion or Early Termination
If at any time during the course of the evaluation the adoptive parents abate their will to adopt or the court finds it unnecessary for the evaluation to continue, it will be discontinued, and court documentation with a Judge’s signature will be needed to cease such order for the need an evaluation. Feesof $150 an hour will be assessed for work performed and refunds will be processed as due at the end of the month following receipt of a written statement from the court that the evaluation has been halted. If the home visit has already transpired for the evaluation, no refunds will be available.
Fees for Appearances and Depositions
I also understand that the above fee does not include court appearances or depositions. If there is a need wishes for me to testify, I understand that the evaluator requires7 business days’ noticeto plan accordingly. The fee for such service is $800 for a half day (or less) or $1,600 for a full day. Fees are to be obtained before the appearance date. At least 48 hours’ notice is also required to cancel and/or reschedule an appointment or relinquish the need for an expert at a court hearing without being charged.
Consent
By my signature below, I acknowledge that I have received and read the informational letter directing me on how to proceed with my adoption evaluation. I have also read and understand that Jessica L. Rogers, MA, LPC is an independent evaluator with Social Study Solutions and that this contract is only with her, and not any other individual. I authorize Jessica L. Rogers to complete the evaluation and provide recommendations to the court and agree to the rules, fees, and guidelines set forth above.
Signed: ______Date: ______
Notary: ______Date: ______