This Forensic Psychological Evaluation is being conducted at the request of a third party and is therefore somewhat different than other psychological services. It is important for you to understand how a forensic evaluation differs from more traditional psychological evaluations. While the results of this evaluation may or may not be helpful to you personally, the goal of this evaluation is to provide information about how you are functioning psychologically to the individual or agency requesting the evaluation. In most cases, this evaluation is intended for use in some type of a legal proceeding. As such, the confidentiality of the evaluation and the results is determined by the rules of that legal system. If your attorney has requested this evaluation, he/she will receive a copy of my report and will control how it is to be used and who has access to it. Normally, the results of this evaluation are protected by the attorney-client privilege. Exceptions to this might include a determination on my part that you are dangerous to another person or if you reveal information that a child has been abused. I would also have to release this information if a court orders me to do so. There may be other examples where the laws require me to release the information obtained during the evaluation. We will discuss these situations on a case-by-case basis. Once a decision has been made to use the report in a legal proceeding, the report and any information pertaining to it will probably be admissible into evidence as well as any other information that was provided concerning your mental health and functioning. If you have any concerns about the use or distribution of my report, you should discuss these issues carefully with your attorney. If someone other than your attorney requested the evaluation, that individual is my client and he/she has complete authority over the results, including whether or not any information will be released to you or to anyone else. Therefore, if another party requested the evaluation, the confidentiality may have fewer legal protections. I will not release the information unless instructed to do so by the person or entity that hired me or when I am legally required to do so. Your participation in this evaluation is voluntary. I will not conduct the evaluation without your signature on this document. You also have the right to stop the evaluation at any time. There may be legal consequences if you stop the evaluation; therefore, it would be in your best interest to consult with an attorney before doing so. In addition, it may be necessary for me to review other related materials such as court records, depositions, transcripts, medical records, etc. If, at any time, you have a question about any aspect of the evaluation or these procedures, please feel free to ask me. In addition, if at any time you need a break from the evaluation, please let me know and we will stop.
I have read and agree to the above:
I hereby authorize Ray S. Kim, Ph.D. and Associates, Inc. to release to and receive from the following collateral contact:
Illinois State Police Firearm Record Challenge Unit ATTN: Triage801 South 7th StreetSuite 400 - NSpringfield, IL 62703
In signing this form, I understand the following provisions:
a) I am under no obligation to sign.
b) I have the right to inspect and copy any information disclosed.
c) I have the right to revoke this authorization at any time by written request (except for information already disclosed).
d) Failure to sign will mean that information will not be requested or released.