Forensic Services Page Form

1
What type of forensic service are you seeking?* This field is required.Please note that most insurance plans do not cover forensic services, and we are currently not providing therapeutic or non-forensic evaluations. Additionally, we do not accept Probation Vouchers. For clinical evaluations or other services not available at our practice, please visit our Resources page for local referral options.
Recidivism Risk Evaluation (Sexual, Violence, General Criminogenic Risks)
Juvenile Transfer Evaluation
Criminal Competency or Criminal Responsibility Evaluation
Pre-Sentencing Evaluation
Fitness For Duty/Return to Work Evaluation
Immigration Proceedings Evaluation (Asylum, Hardship, etc.)
Guardianship or other Capacity Evaluation
Consultation
Other
2
Your Name:* This field is required.
First Name
Last Name
3
Your E-mail:* This field is required.
example@example.com
4
Your Phone:* This field is required.
5
Is the subject of the evaluation yourself or someone else?* This field is required.
Self
Someone else
6
Full Name of Person to be Evaluated:* This field is required.
First Name
Last Name
7
What is your relationship to the subject?* This field is required.
Attorney
Probation Officer
Parole Officer
Case Worker
Family Member/Friend
Other
8
Age of Person to be Evaluated:* This field is required.
9
Is this evaluation court-ordered?* This field is required.
Yes
No
Not Sure
10
Do you have any upcoming court dates or deadlines?
Dates/Deadlines
11
Who is the referring attorney, legal professional, or agency representative? (if applicable)* This field is required.Who indicated the evaluation was necessary? You, your attorney
Name, profession
12
Is this evaluation related to any alleged criminal offenses? If so, please list the allegations, charges, and/or convictions below.* This field is required.
13
Please briefly describe the reason for the evaluation.* This field is required.
14
How do you prefer we get in touch?* This field is required.
Phone
Email
15
May we leave a message ?* This field is required.
YESNO
Should be Empty: