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

Court Service Request Form

Court Request Form (CSR)

Who does the letter need to be sent to?

Physical Address/Virtual Address for Therapist Appearance

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

Credentials

Evidence-Based Therapy

Reviews

Trusted