Court Service Request

Although it is our hope you would not require the services of the courts to resolve disputes, we recognize there are times when it is essential. For these occasions, MCO is able to provided needed reports and documentation to assist. We can also be called on to testify in person, though reports and letters to the court are generally sufficient. Listed below, you will find the fees associated with the different services we provide. Fees for Court Services are due in full 10 days prior to service being rendered. Reduced fees/Scholarships are not available for court services.

Letter to the Court: Useful in cases where a brief update on progress in treatment is needed. Letters to the Court include the client’s identifying information (name, date of birth & social security number), client defined presenting problem for treatment, the frequency and duration of treatment (when the client was first seen, how long they have been in counseling, and how often, example: 1 time per week), treatment goals, and progress on treatment goals. Generally 1-2 pages in length. Please advise on date letter is needed. (1hrs)

Court Report: When a more substantial report is preferable. A Court Report is prepared by a Licensed Professional Counselor, it is not a Psychological Evaluation completed by a Licensed Psychologist. A Court Report includes all the items listed in the Letter to the Court. It also includes, treatment diagnostic information, psychosocial history, and treatment recommendations. Generally 4-5 pages in length. Please advise on date report is needed. (2hrs)

Testifying: If you wish your counselor to testify in your case this can be arranged. Our primary concern is your well-being. Prior to agreeing to testify, your counselor will want to speak with you about why you feel this would be beneficial. If your counselor is concerned testifying in person might be harmful in some way to you as a client, they will notify you of the concern and make alternate recommendations. These might include writing a Letter to the Court or a Court Report. In the event testifying is the best option, our counselors can be reserved for a minimum of four hours. Time beyond that is billed at our court services hourly rate. We do not bill partial hours, so, if an hour is started, the client is responsible for paying for the entire hour. Additionally, if services are completed prior to that hour lapsing, the service is considered completed and our counselors are released from obligation. An exception can be made in the event there is an official or legitimate reason for them to remain. They cannot be asked to stay simply because the hour has been paid. Drive time for your counselor is considered a billable service hour, at the hourly rate. Additionally, there is a mileage charge of $0.75 per mile. Driving distances will be determined based on the MCO Offices as a starting and ending point. (4hr minimum)

Billing: Following the completion of this form, MCO will provide you with an invoice. This invoice must be paid prior to any service being rendered. Please expect any requested legal service to be billed at the forensic rate of 1.5 times your therapist’s hourly rate.

Cancellation/Refund Policy: On occasion, the court services initially requested may not be needed. We advise all clients to confer with their legal counsel prior to requesting any court service, to determine if it is required and what kind of service is needed. Additionally, clients should determine with their legal counsel the date when such services are due. In the event the court service requested is no longer needed, please see the following:

Letters & Reports

Cancellations made seven business days prior to due date for the letter/report will be refunded minus a $50 deposit.
Cancellations made less than seven business days prior to the due date for the letter/report cannot be refunded.

Testimony

Cancellations made seven business days prior to the scheduled court date for testimony will be refunded minus a $200 deposit.
Cancellations made less than seven business days prior to the scheduled court date for testimony cannot be refunded.

"*" 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

Sign Release: All client information is protected under HIPPA and requires signed authorization for release. Please use the link here to provide signed authorization for MCO or its representative to release information. Examples of legal parties to release information to include attorneys, courts, and other legal entities. Access the Authorization to Disclose and Release Protected Health Information Form here.