Polygraph Exam Scheduling Form
Use this form to request and schedule a polygraph exam appointment and provide the details needed to prepare for the exam.
Applicant and Contact Details
Full Name
*
First Name
Middle Name
Last Name
Preferred Contact Method
*
Phone
Email
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Best Time to Contact
Hour Minutes
AM
PM
AM/PM Option
Exam Scheduling Details
Preferred Exam Appointment
*
Alternative Date and Time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Preferred Testing Location
Please Select
Main Office
Downtown Center
West Side Center
Remote/Virtual
Other
Reason for Exam Scheduling
*
Please Select
Pre-Employment Screening
Employment Verification
Internal Investigation
Legal/Compliance Matter
Periodic Review
Other
Scheduling Constraints or Availability Notes
Background and Exam Preparation
Subject / Case Reference
*
Previously Taken a Polygraph Exam?
*
Yes
No
Unsure
Pre-Exam Instructions Acknowledgment
*
I understand and agree to follow pre-exam instructions
I will arrive on time and prepared
I will contact the office if I need to reschedule
Other
Current Medications or Conditions Affecting Exam Preparation
Special Accommodation or Accessibility Request
Additional Notes and Follow-Up
Additional Notes or Instructions for the Examiner
Preferred Follow-Up Method
Please Select
Email
Phone
Text Message
No Follow-Up Needed
Other
Comments
Schedule Exam
Should be Empty: