Court-Ordered Professional Evaluation Request Form
Submit your request for a professional evaluation as mandated by a court order. Please provide all required information to ensure timely processing.
Requester Full Name
*
First Name
Last Name
Requester Email Address
*
example@example.com
Requester Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Role of Requester
*
Please Select
Attorney
Court Clerk
Probation Officer
Judge
Other
Subject of Evaluation (Full Name)
*
First Name
Last Name
Case Number
*
Court Name / Jurisdiction
*
Type of Evaluation Requested
*
Psychological Evaluation
Substance Abuse Assessment
Parenting Capacity Evaluation
Competency Evaluation
Other
Brief Background and Reason for Evaluation
*
Assessment Focus Areas (Select all that apply)
*
Mental Health Status
Substance Use
Family Dynamics
Risk Assessment
Other
Preferred Evaluation Completion Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluation Priority Level
*
Urgent (within 7 days)
Standard (within 30 days)
No Preference
Please rate the importance of the following assessment attributes for this evaluation.
Rows
Not Important
Somewhat Important
Very Important
Thoroughness of Report
1
2
3
Evaluator Credentials
4
5
6
Turnaround Time
7
8
9
Courtroom Testimony Availability
10
11
12
Upload Court Order or Related Documents (if available)
Upload a File
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Choose a file
Cancel
of
Submit Request
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