The Forensic Evaluations Intake Form is used by law enforcement and prosecutors to gather information about an individual who is being evaluated for their involvement in a crime.
Date of birth:
Place of birth:
Social security number:
Driver's license number:
How long have you been employed there?
Do you have any prior convictions?
If yes, please list them:
Have you ever been evaluated by a mental health professional?
If yes, please list the name and contact information of the mental health professional:
What is the nature of the crime you are being evaluated for?
When did the crime occur?
Where did the crime occur?
Who was the victim of the crime?
What was the relationship between you and the victim?
What is your version of events surrounding the crime?
Do you have any witnesses who can corroborate your version of events?
If yes, please list their names and contact information:
What is your criminal history?
Do you have any history of mental illness?
If yes, please list the name and contact information of the mental health professional who diagnosed you:
Do you have any history of substance abuse?