Richardson Polygraph LLC
New Client Intake CONFIDENTIAL
All information will be treated as private and confidential
Client Name (person paying)
*
First Name
Last Name
Cell Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Examinee Name
*
First Name
Last Name
Examinee Date of Birth
*
MM/DD/YYYY
Testing Time Preference
Please Select
Morning (10:00 a.m.)
Afternoon (2:00 p.m.)
Other
We can arrange other times if needed
Allegation/Background
*
Include meaningful dates and locations
Examinee Language Preference
We have Spanish speaking interpreters if needed
Testing day of week preferences
Submit
Should be Empty: