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Purchase Order Psychologist in United States Houston –Free Word Template Download with AI

PO No. HOU-PSY-2025-04872

Psychologist Professional Services — United States Houston

Date of Issue: June 15, 2025

Field Details
Organization Name Gulf Coast Behavioral Health Services, LLC
Address 4520 Westheimer Road, Suite 310, United States Houston, Texas 77027
Contact Person Dr. Margaret Ellison, Director of Clinical Operations
Phone (713) 555-0142
Email [email protected]
Tax ID (EIN) 74-2839105
Field Details
Provider Name Dr. James R. Whitfield, Ph.D., Licensed Psychologist
Practice Address 2200 Post Oak Boulevard, Suite 1800, United States Houston, Texas 77056
Licensure Number TX-PSY-2019-44871 (Texas State Board of Examiners of Psychologists)
Phone (713) 555-0298
Email [email protected]
Specialization Clinical Psychology, Cognitive Behavioral Therapy, Neuropsychological Assessment

This Purchase Order is issued by Gulf Coast Behavioral Health Services, LLC to engage the services of a licensed Psychologist operating in United States Houston to provide comprehensive clinical and consultative services as outlined below. The Psychologist shall deliver all services in accordance with the standards established by the Texas State Board of Examiners of Psychologists and the American Psychological Association (APA) ethical guidelines.

Item # Description of Psychologist Service Quantity Unit Rate (USD) Extended Amount (USD)
001 Individual clinical therapy sessions (50 minutes each) provided by the Psychologist at the United States Houston office 120 sessions $225.00 $27,000.00
002 Group psychotherapy facilitation (90 minutes per session) led by the Psychologist 48 sessions $350.00 $16,800.00
003 Neuropsychological assessment and comprehensive written report per patient 35 assessments $1,200.00 $42,000.00
004 Consultation and supervision hours for in-house clinical staff (per hour) 60 hours $175.00 $10,500.00
005 Emergency crisis intervention response (on-call retainer, monthly) 12 months $850.00 $10,200.00
006 Psychological evaluation for employment fitness-for-duty (per evaluation) 20 evaluations $950.00 $19,000.00
TOTAL PURCHASE ORDER AMOUNT $125,500.00

All Psychologist services referenced in this Purchase Order shall commence on July 1, 2025, and conclude on June 30, 2026. The Psychologist shall maintain a minimum availability of 32 clinical hours per week at the designated United States Houston facility located at 4520 Westheimer Road. Session schedules shall be coordinated in writing no fewer than fourteen (14) calendar days in advance. Any rescheduling must be communicated to the purchasing entity no later than 48 hours prior to the scheduled appointment.

  • Payment shall be made via electronic funds transfer (EFT) to the account designated by the Psychologist in writing.
  • Invoices are due within thirty (30) days of the last day of each calendar month in which services were rendered.
  • A late payment penalty of 1.5% per month shall apply to any invoice not settled within the stated period.
  • All amounts are stated in United States Dollars (USD) and are inclusive of applicable Texas state and Harris County taxes where required by law.
  • The purchasing entity reserves the right to withhold payment for any service not rendered to the professional standard expected of a licensed Psychologist in the State of Texas.
  • Licensure and Compliance: The Psychologist warrants that he holds an active, unrestricted license to practice psychology in the State of Texas and shall maintain all required continuing education credits throughout the term of this Purchase Order. The Psychologist shall comply with all federal, state, and local regulations applicable to the practice of psychology in United States Houston, including HIPAA privacy and security requirements.
  • Confidentiality: All patient records, clinical notes, and proprietary information exchanged under this Purchase Order shall be treated as strictly confidential. The Psychologist shall not disclose any client information to third parties except as permitted by law or with written client consent.
  • Insurance and Indemnification: The Psychologist shall maintain professional liability (malpractice) insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 in aggregate. A certificate of insurance shall be provided to the purchasing entity prior to the commencement of services.
  • Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of a material breach, the non-breaching party may terminate immediately upon written notice. Termination shall not affect obligations accrued prior to the effective date of termination.
  • Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Texas. Any disputes arising hereunder shall be resolved through binding arbitration in United States Houston, in accordance with the rules of the American Arbitration Association.
  • Force Majeure: Neither party shall be liable for failure to perform obligations due to events beyond reasonable control, including but not limited to natural disasters, pandemics, or governmental orders affecting operations in United States Houston.
  • Non-Exclusivity: This Purchase Order does not create an exclusive relationship. The Psychologist retains the right to provide services to other clients and organizations, provided that such engagements do not create a conflict of interest with the services owed under this Purchase Order.

By signing below, both parties acknowledge that they have read, understood, and agree to all terms, conditions, and specifications set forth in this Purchase Order for Psychologist services in United States Houston. This document constitutes a binding agreement effective as of the date of the last signature.

For the Purchasing Entity:

Gulf Coast Behavioral Health Services, LLC

Dr. Margaret Ellison
Director of Clinical Operations
Date: ______________________

For the Service Provider:

Dr. James R. Whitfield, Ph.D.

Dr. James R. Whitfield
Licensed Psychologist, TX-PSY-2019-44871
Date: ______________________

Purchase Order No. HOU-PSY-2025-04872 — Psychologist Services — United States Houston, Texas

This document is the property of Gulf Coast Behavioral Health Services, LLC. Unauthorized reproduction or distribution is prohibited.

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