Client Intake Evaluation

Client Intake Evaluation and Engagement Agreement

Client Name:   Service Provider Name:

WHEREAS

WHEREAS, Client has requested that Service Provider perform certain professional services described herein; and

WHEREAS, Service Provider represents that it has the necessary experience, personnel and resources to provide the requested services and agrees to render such services on the terms set forth in this document.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties agree as follows:

Client Intake Information

Presenting Concerns and Objectives

Scope of Work

Service Provider will perform the following services for Client. Specific tasks, deliverables and acceptance criteria must be reasonably detailed below.

Payment Terms

Client agrees to pay Service Provider the fees described below in exchange for the performance of the Scope of Work.

Term and Termination

This Agreement commences on the Start Date and, unless earlier terminated in accordance with this Agreement, continues until the End Date or completion of the Scope of Work.

Either party may terminate this Agreement for material breach by the other party if such breach remains uncured for the specified notice period after written notice. Termination does not relieve Client of the obligation to pay for services performed and expenses incurred prior to termination.

Confidentiality

Each party acknowledges that it may receive Confidential Information from the other. "Confidential Information" means all non-public, proprietary or business information disclosed in written, oral or electronic form. Each receiving party agrees to: (a) hold Confidential Information in strict confidence; (b) use Confidential Information solely to perform obligations under this Agreement; and (c) restrict disclosure to employees, contractors or agents who need access and are bound by confidentiality obligations no less protective than those herein. Confidential Information does not include information that is already in the public domain, independently developed without reference to the other party's Confidential Information, or rightfully obtained from a third party without restriction.

Records, Data and Retention

Service Provider will maintain records related to services performed for a reasonable retention period and will make such records available to Client upon reasonable request for verification of performance and invoicing. Any personal data will be processed in accordance with the parties' confidentiality obligations set forth above.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles. Venue for any dispute arising from this Agreement shall be in the courts located in that State.

Entire Agreement and Amendments

This document, including any attachments or written statements of work incorporated by reference, constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, representations and understandings, whether written or oral. Any modification or amendment must be in writing and signed by authorized representatives of both parties.

Representations and Client Certification

Client represents and warrants that the information provided in this intake evaluation is accurate to the best of Client's knowledge. Client authorizes Service Provider to rely on the information provided and to proceed with evaluation and engagement in accordance with the Scope of Work. Client acknowledges responsibility for timely payments as provided in Payment Terms.

Consents and Authorizations

By signing below, Client authorizes Service Provider to commence work as described herein and acknowledges receipt of a copy of this Agreement. Client further authorizes Service Provider to contact any referenced third parties for purposes of performing the Scope of Work.

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