(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 service psihologice nr.____________________

,in vederea:_______________________________________________________.

Concluziile examinarii psihologice:

Apt psihologic pentru:____________________________________________

__________________________________________________________________

Inapt psihologic pentru:__________________________________________

__________________________________________________________________

Alte concluzii:___________________________________________________

Observatii:______________________________________________________

__________________________________________________________________

Recomandari:___________________________________________________

__________________________________________________________________.

Examinator Forma de exercitare a profesiei de psiholog

(semnatura si parafa) (semnatura si stampila)