Clinical Evaluation Contract
Anyone who receives a DUI in Georgia is required to attend DUI School, have a clinical evaluation from a State approved Clinical Evaluator, and complete any treatment recommendation with a State approved Treatment Provider. These requirements, effective 7/1/1997 and 7/2008 are State law. The State approved evaluators and treatment providers can be found on the web at
. Other conditions may be required for license reinstatement fees. Call the Department of Driver's Services at 678-413-8400 for more information on your case.
Thank you for choosing me to conduct your clinical valuation. By agreeing and doing your electronic signature below, you agree to the following:
* The client will select a clinical evaluator from the State Registry and have the DUI School forward the NEEDS assessment to that evaluator.
* The client will select any evaluator they wish from the Registry.
* The client is entitled to a second opinion.
* The client will select a treatment provider from the State Registry. If this is not done within 60 days of the evaluation, the evaluator may conduct another evaluation.
* The client will pay the clinical evaluation fee of a minimum of $110 in full at the time of service.
* The Clinical Evaluator (CE) attests that they are currently on the State Registry of approved Clinical Evaluators.
* The CE will determine the level of treatment recommended not the place or length of treatment.
* The Treatment Provider determines the number of groups.
* The CE will show the client the list of State approved treatment providers on the Registry.
* The CE will forward the necessary forms and information to the selected treatment provider after the client signs the necessary release of information form.
By clicking and e-signing below, I agree that I have read and understood the terms of this agreement and received a copy of this contract.
Please acknowledge below:
I agree that I have read and understood the terms of this agreement and have received a copy of this contract. (One will be emailed to me upon signing.)
Please type your full name below:
A copy of your responses will be emailed to the address you provided.
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