Jeffrey Nelson, LCSW, PLLC
1805 S. Bellaire St. Ste. 219
Denver, CO 80222

This is to verify that you have been advised that Jeff Nelson, LCSW does not provide any consultations, or documentation, for the determination of short-term or long-term disability claims. Mr. Nelson does not provide court testimony or documentation for any legal processes to include custody issues, criminal charges or any other civil or legal issues. If either of the above becomes necessary, client agrees to pay Mr. Nelson the hourly rate of $420.00 for court testimony and report / letter-writing and up to $.39 per page for copying chart documents.

By signing below, you agree that you have been advised of these provisions and / or exclusions.