To schedule an appointment for a polygraph test, please complete all the fields in the form below and press the SUBMIT button when done. A staff member will contact the client requesting the polygraph test usually within 6 hours of receipt of the below information to confirm all details. Every effort will be made to accommodate the requested appointment date and time of the polygraph test. All information submitted is private and strictly confidential.

CLIENT INFORMATION (PERSON PAYING FOR TEST)

EXAMINEE INFORMATION (PERSON TAKING TEST)
Full Name of Client: *
Company or Agency Name:
Street Address: *
Suite or Apt No.:
City: *
State: *
Zip Code: *
Primary Telephone: *
Alternate Telephone:
Contact E-Mail: *
My Classification:
Polygraph Test Category:
Relationship to Examinee:
Requested Date of Polygraph Test:*
Requested Time of Polygraph Test:*
Special Notes/Comments:
   
   
Full Name of Examinee: *
Company or Agency Name:
Street Address:
Suite or Apt No.:
City:
State:
Zip Code:
Primary Telephone:
Alternate Telephone:
Contact E-Mail:
Current Age or Date of Birth: *
   
   
Enter Verification Text:  
   
By pressing the submit button above, I confirm I have read, understood and agree to Central Polygraph Service Limited’s Terms and Conditions of Service as well as the Test Fees and Cancellation Policy once an appointment has been officially confirmed by a staff member.