Legal Phone Exams Form

LEGAL PHONE EXAMS FORM

This Legal Phone Exams Agreement is made and entered into by and between Client Name: and Exam Provider: on the date of:

RECITALS

WHEREAS, Client Name: seeks to obtain a telephonic examination by a qualified examiner for purposes of legal, administrative, or insurance proceedings; and

WHEREAS, Exam Provider: is prepared to conduct such telephone examinations consistent with professional standards and the terms set forth herein; and

WHEREAS, the parties desire to set forth the terms governing scheduling, consent to recording, release of records, confidentiality, fees and other matters relating to the telephone examination(s).

NOW THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement: "Phone Examination" means a structured interview and assessment conducted by telephone or secure telecommunication by the Examiner; "Examiner" means the individual or entity identified as Exam Provider; "Participant" means the Client or individual who is the subject of the examination; and "Recording" means any audio or audiovisual recording made in connection with the Phone Examination.

2. SCOPE AND PROCEDURE

The Examiner will conduct the Phone Examination limited to the matters identified in the engagement. The parties agree the proposed exam date is at (Time Zone: ).

The Participant shall be available by telephone at the primary contact number provided below and shall verify identity to the Examiner's reasonable satisfaction. The Examiner may limit the duration and scope of questioning to matters reasonably related to the relevant legal or administrative issues.

3. RECORDING AND CONSENT

The Participant hereby expressly consents to the Recording of the Phone Examination. Consent to record: Yes

The parties acknowledge that Recordings, transcripts and written notes created in connection with the examination are the Examiner's work product and may be retained and used by the Examiner and any retaining party for purposes of legal representation, defense, case evaluation, expert disclosure, litigation and settlement discussions. The Participant understands that recording may affect confidentiality and waives any claim that the mere act of recording invalidates use of the recording in a proceeding.

4. CONFIDENTIALITY; PRIVILEGE

Information disclosed during the Phone Examination shall be treated as confidential by the Examiner to the extent required by applicable professional and legal obligations. Notwithstanding the foregoing, confidentiality does not apply to disclosures reasonably necessary for the preparation of expert opinions, testimony, or in response to lawful process, and does not create or alter any legal privilege applicable to communications between the Participant and his or her counsel.

5. AUTHORIZATION AND RELEASE

The Participant authorizes the release of medical, employment, and other records reasonably requested by the Examiner in connection with the Phone Examination. Participant authorizes third-party custodians to provide such records to the Examiner and to the retaining party.

6. FEES, CANCELLATION AND PAYMENT

The fee for the Phone Examination shall be: $. Unless otherwise agreed in writing, the retaining party is responsible for timely payment of the fee and any reasonable administrative or transcription charges.

Cancellation by the retaining party with less than days' notice may result in a cancellation fee equal to the lesser of the full examination fee or a portion thereof as determined by the Examiner.

7. REPRESENTATIONS, WARRANTIES AND INDEMNITY

Each party represents and warrants that it has full authority to enter into this Agreement, that the information provided to the Examiner is true and accurate to the best of its knowledge, and that it will comply with applicable laws and ethical obligations. The retaining party shall indemnify and hold harmless the Examiner and its agents from and against any claims, liabilities, losses or expenses (including reasonable attorneys' fees) arising from use of the Recording or transcripts in a manner inconsistent with this Agreement or applicable law.

8. NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses provided below. Notice is effective upon personal delivery, confirmed electronic delivery, or three business days after deposit in the U.S. mail with first-class postage prepaid.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Agreement may be amended or modified only by a writing executed by both parties. No waiver of any provision will be effective unless in writing and signed by the party granting the waiver. This Agreement may be executed in counterparts, each of which will be deemed an original, and all of which together will constitute one and the same instrument.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction identified for dispute resolution: , without regard to conflict of law principles. This Agreement constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior agreements and understandings. If any provision is held invalid or unenforceable, the remaining provisions will remain in full force and effect.

11. MISCELLANEOUS

The obligations and benefits of this Agreement shall inure to the parties and their respective successors and permitted assigns. Neither party may assign this Agreement without the prior written consent of the other, except that the Examiner may assign its rights to invoices or fees to a successor or assignee.

ACKNOWLEDGMENTS

The undersigned acknowledge that they have read, understand, and agree to the terms contained in this Legal Phone Exams Form and have authority to bind the party on whose behalf they sign.

Sign Now