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 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 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 EllisonDirector of Clinical Operations
Date: ______________________
For the Service Provider:
Dr. James R. Whitfield, Ph.D.
Dr. James R. WhitfieldLicensed Psychologist, TX-PSY-2019-44871
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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