You can always press Enter⏎ to continue
Questionnaire for Attorneys (CRIMINAL)
Attorneys inquiring for CRIMINAL cases, please fill out the following information. All information is secure through our HIPPA compliant database.
10
Questions
START
1
1. I am the:
Public/Private Defense Attorney
District Attorney
Previous
Next
Submit
Press
Enter
2
2. Inquiring about:
Competency to Proceed
Mental Status at Time of Offense (“insanity”)
Risk Assessment (e.g., sex offender)
Death Penalty
Mitigation
Sentencing
Specific Intent
Diminished Capacity
Previous
Next
Submit
Press
Enter
3
Inquiring about Competency to Proceed
Competency to stand trial
Plead guilty
Waive one’s right to counsel
Competency to be sentenced
Competency to be executed
Previous
Next
Submit
Press
Enter
4
3. To your knowledge, does the Defendant have a history of Traumatic Brain Injury (TBI)?
Leave Blank if Unknown
YES
NO
Previous
Next
Submit
Press
Enter
5
4. To your knowledge, has the Defendant already undergone a forensic psychological and/or neuropsychological evaluation specific to this case?
YES
NO
Previous
Next
Submit
Press
Enter
6
If so, When (mm/yyyy) ?
mm/yyyy
Previous
Next
Submit
Press
Enter
7
5. Is there a timeframe in which the Defendant would need to be evaluated?
Within the next month
Within the next 2-3 months
Within the next 4-6 months
Undetermined
Previous
Next
Submit
Press
Enter
8
Please provide your contact information:
Name:
Law Firm:
Phone:
E-mail:
Previous
Next
Submit
Press
Enter
9
How would you prefer to be contacted?
Email
Phone Call
Text
Previous
Next
Submit
Press
Enter
10
Please upload any relevant medical and/or legal records to our secure HIPPA compliant database, so that we may review the case appropriately prior to responding to this inquiry.
Helpful documents can include: • Charging documents/Arrest reports/Rap Sheet • Previous neuropsychological and/or psychological and/or academic evaluation reports • Any brain/head neuroimaging result reports • Reports from specialty providers (e.g., neurology, psychologist, psychiatrist).
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
10
See All
Go Back
Submit