Schedule a Polygraph Exam

To schedule an appointment for a polygraph test, please complete all the fields in the form below and press the Send button when you have completed the form.We will contact you, usually within 6 hours of receipt of the below information to confirm all details. Every effort will be made to accommodate the appointment date and time you request for the polygraph exam. Any information that you give us in this form will be treated as private and strictly confidential.

    Person Paying for the exam:
    Person Taking the exam:
    *Full Name
    *Full Name
    Company/Agency Name:
    Company/Agency Name:
    *Street address:
    Street address:
    Suite/Apt #:
    Suite/Apt #:
    *City:
    *City:
    *State:
    *State:
    *Zip Code:
    *Zip Code:
    *Primary Phone:
    *Primary Phone:
    *Alternate Phone:
    Alternate Phone:
    *Email:
    *Email:
    Relationship to Examinee:
    *Date of Birth or Age:
    Payee is a/an:
    Type of Test:
    *Requested Date:
    *Requested Time: