Reporting Party Statement and Intake Information

Reporting Party Statement and Intake Information
This form is STEP 2 in the polygraph exam process. Do not complete this form until you have a confirmed appointment date.

This form is for the person making the accusations against the Subject taking the exam, otherwise known as the Reporting Party. Only the Reporting Party is permitted to complete this form. This person may be the Subject's spouse, signficant other, the alleged victim or anyone who is making the allegation against the Subject.

This form is compromised of 11 different sections, A-J.

A: Exam Verification

B: Reporting Party's Information

C: Subject's Information

D: Disclaimers

E: Statement Collection

F: Question Submission

G: Evidence Collection (Option to Upload Files)

H: Credibility Assesment

I: Policies & Notices

J: Signature & Form Submission

Depending upon your responses, this form may take anywhere from 20 minutes to 45 minutes to complete.

Section A: Verify the Exam(s) is Already Scheduled
SECTION A: VERIFY YOUR EXAM

Before completing this form, you should have already scheduled and paid for your exam online during Step 1. Please verify your exam information below.
What is the confirmed date of the Subject's scheduled polygraph and/or EyeDetect exam? *

MonthDayYear
This was the date you selected in Step 1 when you booked and paid for your exam online.
What type of exam(s) is scheduled?*
This is the service you paid for when you scheduled your exam online during Step 1.

Section B: REPORTING PARTY'S INFORMATION
SECTION B: THE REPORTING PARTY'S INFORMATION

The Reporting Party is the Accuser or Victim that is making the allegation against the Subject.

If this is an infidelity (cheating) case, then the Reporting Party is the Subject's significant other (spouse, girlfriend, boyfriend, etc.)

For all other cases, the Reporting Party is the person making the allegations against the Subject such as the victim, a parent of child that was sexually abused, etc.
Reporting Party's Full Legal Name*
Reporting Party's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Map Locator
Reporting Party's Phone Number*
Reporting Party's Email*
example@example.com
Is the victim/accuser in this case a minor?*

YesNo
May we contact you, the Reporting Party?*

YesNo
Take Photo: To verify that you, the Reporting Party, are the person filling out this form, please take of yourself. *

Section C: SUBJECT'S INFORMATION
SECTION C: THE SUBJECT'S INFORMATION

The Subject is the person taking the polygraph or EyeDetect exam. The Subject is the person that you, the Accuser, are making the allegations against.
Subject's Full Legal Name*
The Subject is the person taking the exam.
Subject's Phone Number*
Subject's Primary E-mail address*
ONLY IF RELEVANT TO THE CASE, list any other phone numbers, emails, social media, Apps, websites or accounts both in true name or in alias name that the Subject has that directly apply to the case:
What is your relationship to the Subject? *
In other words, who are you?
Has the Subject ever been arrested or convicted of a crime? If yes, please explain each arrest and charges in the space below.*

NoYes (Explain in the box below)
If you answered YES, please explain in detail in the box below.
To your knowledge, what motivates the Subject to take action and why?
To your knowledge, what are three specific things the Subject really likes and makes them feel good? (Example: He's a big's Ravens fan, cooking homemade Italian food and Pelton.)
To your knowledge, deep down, what does the Subject care most about and why?
To your knowledge, what does the Subject fear the most and why?
To your knowledge, what is the Subject's most common methods of manipulation or lying? (Example: Gaslighting, being overly difficult/argumentative, etc.)
To your knowledge, describe what you have observed when the Subject has been caught in a lie:

Section D: Lie Detector Test Notice and Disclaimer
SECTION D: NOTICE AND DISCLAIMER
Read the statement below and then check the button to acknowledge that you read, understand, accept and consent to the following statement in regards to taking a lie detector test.*

I understand that all polygraph and/or EyeDetect exams conducted by Validate, LLC will cover ONE and ONLY ONE Single, Specific Issue per exam. I understand that all relevant questions asked on any exam by Validate, LLC will be directly related to the ONE Single, Specific issue being tested. I understand that the polygraph examiner and/or EyeDetect proctor will formulate, write and solely determine the specific questions that will be asked on any exam. I understand that 2 to 4 relevant questions may be asked on the polygraph exam. I understand that only 1 relevant question, which will be asked in a variety of different ways, will be asked on the EyeDetect exam. I understand that if I have multiple issues and/or more questions than is already included that I would need to purchase additional services for an additional fee. I understand that polygraph exams and EyeDetect exams may only test facts and specific actions. I understand that polygraph exams and EyeDetect exams may not test feelings, thoughts, emotions, fantasies, desires, wants or future intentions. I understand that all questions on a polygraph exam will be in a yes or no only format. I understand that all questions on the EyeDetect will be in a true or false only format. I understand that Polygraph exams and EyeDetect exams are not 100% accurate and have a variable margin of error. I understand that the Subject takes the examination at his/her own risk and of his/her own free will. I understand that no refunds will be granted for any reason. I understand, consent and agree to hold harmless and release all liability of any kind against Validate, LLC or its members.

Section E: Statement Collection
SECTION E: STATEMENT COLLECTION
In the space below, tell us the entire story, from beginning to end, without omitting or withholding any details, as to what happen that is causing the Subject to take a lie detector test. There is no text limit. Type as much information as needed to tell the complete story. This statement serves as your voice and point of view so ensure you provide as much detail as possible.*
Do not include questions in your statement. You will have the opportunity to provide questions later in this form.

Section F: Question Submission
In the space below, type the ONE, single most important question you want answered. The question must be short, simple and direct yes or no questions only. Do NOT write a compound, complex, run-on or multi-part question.*
In the space below, type the SECOND most important question you want answered. The question must be short, simple and direct yes or no questions only. Do NOT write a compound, complex, run-on or multi-part question.*

Section G: Evidence Collection
SECTION G: EVIDENCE COLLECTION
In the space below, please tell us about any and all evidence in this case:
Upload a copy of any files, photos or other digital evidence you want to share:

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Upload a copy of any files, photos or other digital evidence you want to share:

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Upload a copy of any files, photos or other digital evidence you want to share:

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Section H: Credibility Assessment
SECTION H: CREDIBILITY ASSESMENT
1. Are you an honest person? Please explain.
2. On a scale of 1 to 10, with 10 being extremely aggressive and 1 being extremely passive, how assertive do you want the Subject treated by the examiner and why?
3. What happens to YOU if the Subject passes the exam?*
4. What happens to YOU if the Subject fails the exam?*
5. Provide the full name of 3 adults that you have a long-term, close & personal relationship with that you have never told a single lie to in your entire relationship?*
6. Are YOU willing to undergo a polygraph exam? Explain why or why not.*
7. Why should the examiner believe you?*
8. A woman's mother passed away due to natural causes. At the funeral, the woman meets the man of her dreams who she knows she is destined to spend the rest of her life with but she doesn't get the man's name or have any contact information. Three days later, the woman kills her only sister in cold blood. What do you think the motive is for the woman killing her only sister? *
9. If the Subject fails, should the Subject be given a second chance?*
10. Statistically speaking, the probability that the Subject will pass the exam is very high. In most cases, the Subject is innocent and has been wrongly accused. How does that make you feel?*

Section J: Sign & Submit
SECTION J: CONFIRM, SIGN AND SUBMIT
I, the Subject, hereby confirm under any applicable laws, that the statements made by me within this form are the truth, the whole truth and nothing but the truth.
Signature*

Clear
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty: