C-26, r. 220 - Regulation respecting the conciliation and arbitration procedure for the accounts of psychologists

Schedule Disposition versions

2012-09-01

SCHEDULE I

(ss. 2 and 4)

APPLICATION FOR CONCILIATION

I, the undersigned _____________________________________________________________________

(name and domicile of the client)

declare that:

(1) __________(name and professional domicile of the psychologist)__________ has claimed from me the sum of ______________________________ for professional services rendered between ______________________________ and ______________________________ as attested to by:

(Check the appropriate box)

[ ] the account, a copy of which is attached hereto.

[ ] the document, a copy of which is attached hereto, indicating that

the sum was withdrawn or withheld.

(2) I am contesting the sum claimed for the following reasons:

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but (where applicable) I acknowledge owing the sum of ______________________________ for professional services rendered.

(Check the appropriate box)

(3) [ ] I did not pay the account

[ ] I paid the account in full

[ ] I paid the account up to the sum of ____________________

(4) I hereby apply for conciliation by the syndic, pursuant to Division II of the Regulation respecting the conciliation and arbitration procedure for the accounts of psychologists (chapter C-26, r. 220).

Signed on ____________________________ ____________________________________________

(Signature of the client)

(“4) An application for conciliation must be sent to the syndic on the form prescribed in Schedule I within 45 days from the date on which the client received the account.

Where the payment of the account has been withdrawn or withheld by the psychologist from the funds that he holds or receives for or on behalf of the client, the period runs from the day on which the client becomes aware of the withdrawal or withholding.

An application for conciliation in respect of an account for which no payment, withdrawal or withholding has been carried out may be sent to the syndic after the expiry of 45 days provided that it is sent before the client is served with proceedings concerning the account.”.

O.C. 145-2000, Sch. I; O.C. 246-2000, s. 1.