Name of Attorney *

First Name

Last Name

Location of Client *

Community

Detention

Is this a request for a telephone or video evaluation outside the New York City area through the Remote Evaluation Network (mental health only)? *

Please email us if you have any questions regarding your client's eligibility for a remote evaluation.

Yes

No

Hearing scheduled? *

Yes (please include date below)

No

Hearing Date (if scheduled)

MM

DD

YYYY

Final Evaluation Affidavit Deadline *

MM

DD

YYYY

Type of Forensic Examination *

Physical

Psychological

Gynecological

Preferred Gender of Evaluator *

Man-identified

Woman-identified

Another preference

No preference

Client is being represented: *

Pro-bono

Reduced-fee

Full-fee