Schedule A Polygraph Examination Please use the form below to schedule a polygraph examination, or call us at (909) 918-6202. Please enable JavaScript in your browser to complete this form.Personal InformationFirst Name *Last Name *Street Address *Apartment or Unit (If any)City *DropdownState*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *Company InformationIf this appointment is being made for an employee or perspective employee, please complete the following fields. If this doesn't apply to you, you can skip this section.Company NameEmployee's First NameEmployee's Last NameDate Of BirthContact InformationCell Phone NumberWork Phone Email Address *Appointment InformationPurpose *Purpose*Law Enforcement Pre-Employment ScreeningPost-Conviction Sex Offender TestingCorporate Theft & Embezzlement TestingChild Abuse, Domestic Violence or InfidelityAttorney-Client Pre-Court TestingIf Other, Please ExplainPreferred Day *Preferred Day*MondayTuesdayWednesdayThursdayFridayAs Soon as PossiblePreferred Time Block *8 am to 10 am10 am to 12 pm12 pm to 2 pm2 pm to 4 pmConfirmation * I understand all information will remain confidential and that by submitting this appointment request, this does not guarantee an appointment. This form only notifies Insight Polygraph Professionals of the desired date, time and purpose of an examination.Submit