Our Court Service Request Form - MyCounselor.Online

Court Service Request Form

Court Request Form (CSR)

Court Request Form

"*" indicates required fields

Name*

First Last

Client's Name

If different from above (ie: person completing this form is the client's legal guardian.)

First Last

Type of Request

Letter

Report

Testimony

Who does the letter need to be sent to?

Contact Information - Where is the document to be sent (please include fax numbers, mailing addresses and/or email addresses if document(s) need to be sent in this manner):

Attorney/Office of the Court Requesting Appearance*

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Fax Number

Email Address

Date Needed

Physical Address/Virtual Address for Therapist Appearance

Attorney/Office of the Court Requesting Appearance*

Is it an option for your therapist to appear virtually (ie: via webcam)?*

Yes

Physical Address for Therapist Appearance

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Virtual Address for Therapist Appearance

Dates Professional's Presence is Requested*

Add additional dates by clicking the +

Time Needed*

Please provide a time range.

Professional Requested**

To whom should an invoice for these services be directed?*

Pre-Payment is required 2 weeks in advance of the requested dates.

Email for Invoice

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Court Service Request Form

Court Request Form (CSR)

Who does the letter need to be sent to?

Physical Address/Virtual Address for Therapist Appearance

Counseling You Can Trust...

Credentials

Reviews

Trusted

Court Service Request Form

Court Request Form (CSR)

Who does the letter need to be sent to?

Physical Address/Virtual Address for Therapist Appearance

Counseling You Can Trust...

Credentials

Evidence-Based Therapy

Reviews

Trusted