Michael Reynard, M.D.
Associate Clinical Professor of Ophthalmology
UCLA School of Medicine
2118 Wilshire Boulevard #614, Santa Monica, CA 90403
reynardmd@gmail.com O: 310/210.0833
AGREEMENT ON STATEMENT OF CONDITIONS AND FEE SCHEDULE FOR MICHAEL REYNARD, M.D.
Case name:_____________________ vs ______________________________
Plaintiff(s) Defendant(s)
I am requesting the consulting services of Dr. Reynard, an ophthalmologist. I agree to pay a non-refundable earned retainer of $___________ for those services before the commencement of such services. I understand that my non-refundable retainer will reserve block time. In addition, payment of earned retainer precludes Dr. Reynard from performing work on this case for opposing counsel. I understand that payment of this retainer does not guarantee Dr. Reynard’s continued services as an expert witness.
I understand that Dr. Reynard will review the documents provided him by my office or me and will render an opinion on the subject matter requested. If the desired opinion is outside his expertise or impossible to render due to lack of technical or other information, he will so advise me as soon as practicable. If, following review of the materials, Dr. Reynard cannot serve as expert witness, he will so advise me as soon as practicable. IN ALL SUCH CASES, I agree to pay the total charges (at the rates stated below) for the review afforded me. I understand that Dr. Reynard reserves the right to decline to undertake work for or work with an attorney, organizational entity, or designated forensic expert on any particular case, and that Dr. Reynard reserves the right to discontinue services.
I understand that advance payments may be required to maintain a –0- balance should payment for charges be delayed over 60 days following receipt of a statement. Unpaid accounts after 60 calendar days following the sending of the initial statement will be subject to the addition of interest charges of 1 and ½% of the balance due per month. Accounts unpaid over 90 days will be subject to cessation of services and adjudication in Courts of Los Angeles County.
FEE SCHEDULE
I UNDERSTAND THAT THE FOLLOWING SCHEDULE OF FEES APPLIES:
$________ per hour for consultation, review of records, trial preparation, travel time and fieldwork. ________ per hour for examination (IME). $__________ per hour for deposition. $___________ for each day, or portion thereof, for arbitration, mediation, or trial testimony. Expenses for materials, travel, travel expenses, and eye testing with instrumentation are additional.
I agree to the above Statement of Conditions and Fee Schedule. Should I question the billing of services, I will advise Dr. Reynard’s office within ten (10) days of receiving a statement of account and related services.
Date_______________
Client Signature_______________________________________
Client Name__________________________
Client Firm___________________________