Global Polygraph Network

Registration for Polygraph Exam

The following registration form must be completed in order to schedule an appointment with a Global Polygraph Network examiner. Once your registration and initial deposit (referral fee) have been received, the examiner who handles your area will contact you within approximately two business days to schedule your appointment at a mutually-convenient date and time. The fee listed for your exam location is the full fee for one exam conducted on weekdays during normal business hours. The deposit/referral fee is NOT an additional fee. The balance of the exam fee (total amount less the deposit/referral fee) must be paid directly to the examiner. The examiner will likely request a second deposit after an appointment has been scheduled. You will receive a confirmation email within 2 business days after your registration has been processed.

ALL QUESTIONS MARKED WITH AN * ARE REQUIRED
PERSON REQUESTING THE EXAM
* Person Requesting Exam
* Street Address
* City
* State or Province
* Zip or Postal Code
* Country (if outside U.S.A.)
* Phone Number
Alternate Phone Number
Email

Exam Location & Fee	OHIO, MANSFIELD OH 2000 Harrington Mem Road - $800 per exam
	Fee does not reflect volume discounts if applicable.
PERSON(S) TAKING THE EXAM
* Number of persons to be tested?	X $400 USD = initial deposit (referral fee)
	NOTE: If you require 3 or more examinations please contact us for volume pricing.
* Name(s) of persons to be tested?
	We do not test children under 12 years of age. Testing of children 12 to 17 years of age requires parental consent.
List any medical conditions of the examinee(s):	>
	Certain medical conditions will require physician approval prior to testing.
List all medications:	>
REASON FOR THE EXAM
* Please select primary purpose for this exam:
If 'other', please explain:	(Maximum characters: 255)
If this exam is to be conducted on the behalf of an employer on a current employee, this type of testing is governed by the federal Employee Polygraph Protection Act of 1988 Please visit our Employee Testing page for more information
Additional Information or Instructions	(Maximum characters: 255)
DEPOSIT REQUIRED
WHY IS A DEPOSIT REQUIRED? Frankly, nearly half of all clients who schedule appointments without a deposit do not show up for their appointments. The deposit helps insure that you are serious about moving ahead with your exam and are not using the "threat of polygraph" merely as a tool to extort information from someone. The deposit is NOT an additional fee. It is only a part of the overall fee, and will be deducted from the total amount. You will pay the balance of the fee directly to your examiner. Please note that your registration will not be complete until your deposit has been received. In most cases deposits are non-refundable (see our refund policy for details).

Please choose one of the payment methods from the dropdown menu below:


NO CREDIT CARD? NO PROBLEM. Pick up a prepaid debit or gift card at many large retail and drug stores.