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

Professional Psychological Services Contract

Los Angeles, California — United States

PO Number: PO-LA-2025-04872

Date of Issue: June 15, 2025

Company Name: Westside Wellness & Corporate Health Solutions, LLC
Address: 4720 Wilshire Boulevard, Suite 1200, Los Angeles, California 90036, United States
Contact Person: Ms. Rebecca Tanaka, Director of Employee Benefits
Phone: (213) 555-0187
Email: [email protected]
Tax ID (EIN): 82-4471903
Professional Name: Dr. Marcus J. Whitfield, Ph.D., Licensed Psychologist
License Number: PSY-1048293 (California Board of Psychology)
Practice Address: 2310 Santa Monica Boulevard, Suite 450, Los Angeles, California 90041, United States
Phone: (323) 555-0264
Email: [email protected]
Specialization: Clinical Psychology, Corporate Wellness, Cognitive Behavioral Therapy (CBT), Stress Management

This Purchase Order authorizes the procurement of professional psychological services rendered by the licensed Psychologist identified in Section 2 for the benefit of the purchasing entity and its employees. All services shall be delivered in compliance with the California Business and Professions Code, the California Code of Regulations Title 16, and all applicable federal regulations governing the practice of psychology within the United States.

Item # Service Description Quantity Unit Rate (USD) Total (USD)
1 Individual CBT Sessions for Corporate Employees (50-minute sessions, in-person at Los Angeles office) 120 sessions $225.00 $27,000.00
2 Group Stress Management Workshops (2-hour sessions, up to 25 participants) 12 workshops $1,800.00 $21,600.00
3 Psychological Assessment and Diagnostic Evaluation (comprehensive battery) 30 assessments $450.00 $13,500.00
4 Executive Coaching and Mental Health Consultation (quarterly) 8 sessions $600.00 $4,800.00
5 Emergency Crisis Intervention and After-Action Psychological Debriefing 4 incidents $1,200.00 $4,800.00
6 Monthly Progress Reporting and Confidentiality Compliance Documentation 12 months $350.00 $4,200.00
TOTAL PURCHASE ORDER VALUE $75,900.00
  • Payment Schedule: Invoices shall be submitted on a monthly basis by the 5th business day following the end of each calendar month. Payment is due within thirty (30) days of invoice receipt (Net 30).
  • Payment Method: All payments shall be made via ACH electronic transfer to the Psychologist's designated business account. No cash payments are authorized under this Purchase Order.
  • Tax Considerations: The Psychologist is responsible for reporting and remitting all applicable federal, state (California), and local (City of Los Angeles) taxes, including self-employment tax and any applicable sales or service taxes as determined by the California Department of Tax and Fee Administration (CDTFA).
  • Late Payment: A late fee of 1.5% per month shall be applied to any outstanding balance exceeding the Net 30 payment window.
  • Currency: All amounts stated in this Purchase Order are in United States Dollars (USD).

This Purchase Order is effective from July 1, 2025 through June 30, 2026, a period of twelve (12) months. The Psychologist shall provide all services within the geographic boundaries of the City of Los Angeles, California, United States, unless otherwise agreed in writing. The Psychologist warrants that all services will be performed in accordance with the American Psychological Association (APA) Ethical Principles and Code of Conduct, the California Board of Psychology practice standards, and the HIPAA Health Insurance Portability and Accountability Act of 1996.

The Psychologist shall maintain a minimum of $2,000,000 in professional liability insurance coverage throughout the term of this Purchase Order and shall provide a certificate of insurance upon request. All client records and psychological data shall be stored in compliance with California Civil Code Section 1798.82 and applicable federal privacy regulations.

  • Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the purchasing entity shall pay for all services rendered up to the effective date of termination.
  • Disputes arising under this Purchase Order shall be resolved through binding arbitration in Los Angeles, California, United States, in accordance with the rules of the American Arbitration Association (AAA).
  • This Purchase Order shall be governed by and construed in accordance with the laws of the State of California and applicable federal law of the United States.
  • The Psychologist shall not assign or subcontract any portion of the services described herein without prior written consent from the purchasing entity.

By signing below, both parties acknowledge and agree to all terms, conditions, and service specifications outlined in this Purchase Order. This document constitutes a binding agreement for the procurement of professional psychological services in the United States, specifically within the jurisdiction of Los Angeles, California.

For the Purchasing Entity:

Westside Wellness & Corporate Health Solutions, LLC

Signature: ___________________________

Name: Rebecca Tanaka

Title: Director of Employee Benefits

Date: ___________________________

For the Service Provider (Psychologist):

Dr. Marcus J. Whitfield, Ph.D.

Signature: ___________________________

Name: Marcus J. Whitfield

Title: Licensed Psychologist, CA License PSY-1048293

Date: ___________________________

Purchase Order PO-LA-2025-04872 | Westside Wellness & Corporate Health Solutions, LLC | Los Angeles, California, United States

This Purchase Order is valid only for the services and terms described herein. Unauthorized reproduction or modification of this document is prohibited. All communications regarding this Purchase Order should be directed to the purchasing entity's procurement office at the address listed in Section 1.

Document generated in compliance with California procurement standards and United States federal contracting guidelines for professional services.

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