<p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="HE" style="font-size:18.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">השירות הפסיכולוגי המשלים</span></span></span></u></b><b><u><span dir="LTR" style="font-size:18.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif"></span></span></span></u></b></span></span></span></span></span></p>
<p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="HE" style="font-size:16.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">בקשה לטיפול</span></span></span></u></b></span></span></span></span></span></p>
<p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:115%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="HE" style="font-size:13.0pt"><span style="line-height:115%"><span style="font-family:"David",sans-serif">*הטיפול בשירות הפסיכולוגי המשלים כרוך בתשלום המעודכן מעת לעת.</span></span></span></span></span></span></span></span></p><p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:115%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="HE" style="font-size:13.0pt"><span style="line-height:115%"><span style="font-family:"David",sans-serif">תושב העיר: 290 ₪ לפגישה </span></span></span></span></span></span></span></span></p><p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:115%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="HE" style="font-size:13.0pt"><span style="line-height:115%"><span style="font-family:"David",sans-serif">תושב חוץ: 310 ₪ לפגישה </span></span></span></span></span></span></span></span><br></p><p align="center" dir="RTL" style="text-align:center; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:115%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="HE" style="font-size:13.0pt"><span style="line-height:115%"><span style="font-family:"David",sans-serif"></span></span></span></span></span></span></span></span></p>
<p><b><span lang="HE" dir="RTL" style="font-size:14.0pt"><span style="font-family:"David",sans-serif"><span style="color:#ee0000">ע"פ הנחיית חוזר מנכ"ל משרד החינוך, השירות אינו יכול להינתן לילדים שקיבלו זכאות לשירותי חינוך מיוחד (גן חינוך מיוחד / כיתת חינוך מיוחד / סל אישי)</span></span></span></b><br></p>
<p dir="RTL" style="text-align:right; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">פרטי התלמיד/ה</span></span></span></u></b></span></span></span></span></span></p>
<p dir="RTL" style="text-align:right; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">פרטי ההורים</span></span></span></u></b><u><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif"></span></span></span></u></span></span></span></span></span></p>
<p dir="RTL" style="text-align:right; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif"><span style="color:#ee0000">*במידה וההורים גרושים או נמצאים בקונפליקט, נדרשת הסכמת שני ההורים לטיפול ע"פ חוק. </span></span></span></span></span></span></span></span></span></p>
<p dir="RTL" style="text-align:right; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><u><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">הורה 1 </span></span></span></u></span></span></span></span></span></p>
<p dir="RTL" style="text-align:right; margin-bottom:8px"><span style="font-size:11pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><u><span lang="HE" style="font-size:14.0pt"><span style="line-height:150%"><span style="font-family:"David",sans-serif">הורה 2</span></span></span></u></span></span></span></span></span></p>
