Aviz psihologic

(in cazul in care nu se aplic se anuleaza formularul cu o linie n diagonal

peste formular)

_____________________________________________________________
(Forma de exercitare a profesiei de psiholog cu drept de libera practica)
Nr. __________/__________________

AVIZ PSIHOLOGIC
Dna./Dl.

__________________________________________________________,

_____________________,

CNP:

a fost examinat la data de: ____________________, in baza contractului de prestari servicii psihologice nr.
______/______________,
n
vederea
obinerii:
______________________________________________________________________________________________.
Concluziile examinarii psihologice:

Apt
psihologic
pentru:
________________________________________________________________________________________

Inapt
psihologic
pentru:
_______________________________________________________________________________________
Alte concluzii: ________________________________________________________________________________________________
Observatie:
________________________________________________________________________________________
____________________________________________________________________________________________________________
Recomandri:
______________________________________________________________________________________
_____________________________________________________________________________________________________________
Examinator (semnatura si parafa),
(semnatura si parafa),

Supervizor
(pentru

examinarile realizate de catre PDLP in conditii de supervizare)

*Avizul psihologic este eliberat in cazurile generale, fiind utilizat numai pentru evaluarile
a caror rezultat este solicitat in vederea angajarii/incadrarii sau mentinerii in functie.
Avizul psihologic reprezinta forma binara sau simplificata de raportare a rezultatelor
psihodioagnosticului.