Polygraph Intake Form

Please read over carefully and answer all questions.

Please click on submit when this form is completed.

NOTE:

This is a separate submission from the Client Intake Form

contact@barclayinvestigations.net

1-833-557-BARC (2272)

Has a polygraph test been completed on the test subject before?

Yes

If a Polygraph Examination has been completed before, please explain?

Reason for polygraph examination?

Test Subjects First and Last Name

Date of Birth (Any format will work)

Height

Weight

Driver's Licence Number

Province/State of Driver Licence

Home Address

Home Phone #

Mobile/Cellular Phone #

Business Phone #

Marital Status

Children?

Yes

Expecting

How many children

Does subject hold any specialized licences or training? (i.e. Trades)

Yes

If the test subject holds any specialized licences or training (i.e. Trades), Please explain.

Is this case to potentially go to court or used in legal proceedings?

Yes

Unknown

Tell us the full story in a condensed version, the who, what, when, where, why and how?

Three (3) questions you would like to ask to prove your innocence or Guilt

By checking this box, I, the test subject agrees that I am over the age of 16 and NOT pregnant.

Test subject acknowledges that a non-refundable deposit is required with the remainder due on the test date. If the test is canceled with less than 24 hours notice, then the full payment is required.

Thanks you for submitting!

Polygraph - Intake Form: Contact Us

Barclay Investigations Inc.

contact@barclayinvestigations.net

1-833-557-BARC (2272)

Orillia, Ontario, Canada

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