Aviz Psihologic

_______________________________________________________________

(Forma de exercitare a profesiei de psiholog cu drept de liber practic/structura de psihologie)Nr. _________/_____________

AVIZ PSIHOLOGIC

Dna./Dl. __________________________________________________________, CNP: __________________________, a fost examinat la data de: __________________________, n baza contractului de prestri servicii psihologice/contractului individual de munc nr. _______/________, n vederea: _______________.

Concluziile examinrii psihologice:

Apt psihologic pentru: ______________________________________________________

Inapt psihologic pentru: _____________________________________________________

Alte concluzii: _____________________________________________________________

Observaii: ________________________________________________________________

___________________________________________________________________________

Recomandri: ______________________________________________________________

___________________________________________________________________________

Examinator, Forma de exercitare a profesiei de psiholog cu drept

(semntur i paraf) de liber practic structura de psihologie

(semntur i tampilat)

PAGE