_______________________________________________________________

(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)