CONTRACTUAL AGREEMENT 



THE LISTENING EAR CMS hereby enters into an agreement with the named company ________________________________________________________, 

Address _________________________________________________________, 

and phone number______________________ to provide one or both services: 

__counseling (circle the ones that apply: individual, couple, family, or group) 

__ mediation or __ both for an agreed time: 

__ day(s), __ week(s), __ month(s), __ year(s) or __ as needed. 

The Listening Ear Services provided can be done either virtually, at the location of the company or at a mutually agreed location. 

The attached Listening Ear CMS Disclaimer and Release of Liability Agreement is a part of this Contract and all participants involved in any or all the services provided will adhere to the rules and regulations set forth. 

Pricing for service(s) is available on a separate document and can be downloaded, reviewed, and discussed prior to signing the compensation agreement. 

It is important that all parts of each document are fully understood and signed before any services are provided. If there are any questions or concerns that need clarification, signing any documents with The Listening Ear CMS is proof that all questions and concerns were explained clearly to the satisfaction of all parties involved. 

__________________________________ Date signed ______________ 

The Listening Ear CMS Rep 

_________________________________ Date signed ______________ 

Authorized Representative for Company 

_________________________________ Date signed ______________ 

Authorized Representative for Company