Litigant Information Survey
Davidson Forensic Group
Pacific Northwest: 800 W. Main STE 1460, Boise, ID 83702
Southwest, Midwest and East: 6860 North Dallas Pkwy STE 200, Dallas, TX 75204
Office (208) 401-9292 Fax (888) 567-9673
 
Save & Return Account: DO THIS FIRST! IF YOU ATTEMPT TO DO THIS LATER, ALL OF YOUR WORK ON THIS FORM WILL BE ERASED AND YOU WILL HAVE TO START OVER.
New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.
ALL INFORMATION PROVIDED IS NOT CONFIDENTIAL

Reason For This Form

The purpose of this form is to gather information about you for your psychological evaluation. Please complete this form yourself. Do not have anyone else complete the form for you. Please answer the questions honestly and to the best of your ability. Do not discuss your answers with anyone else until after you have return this form. Feel free to look up any information that you do not remember. This is not a test of your grammar or spelling. Your answers do not have to be exhaustive - you will have time to elaborate on any issue during your face-to-face interviews. A copy of your completed form can be provided to you at your request. Please email any questions or concerns to Dr. Davidson.

All Information is NOT Confidential

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US citizen? *

Recent Address History

Your Background

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Older Brother(s)
Older Sister(s)
Younger Brother(s)
Younger Sister(s)
 AcceleratedNormalDelayed
Physical Development
Movement (Fine & Gross Motor)
Cognitive Development
Social Interaction
Emotional Interaction
Language & Communication
Residence History (Community & Year) Hit Return After Each Entry
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Childhood Fears?
 
Childhood Trauma?
 

Your Education

High School(s) Attended (School Name, Grade Levels, City, Grades - Hit Return after Each School)
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Extracurriculars In High School (List then Return)
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Colleges or Trade Schools Attended (Name, Grade/Program, City, Grades, Degree - Hit Return after Each School). Leave blank if you did not attend college or trade school.
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Your Occupation

Job History Company/Dates/Position/Reason Left (Most Recent First - Hit Return after Each Job)
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Your Medical History

Specialist(s) Name(s) and Address(es). Please List One Specialist Per Line - Hit Return after Each Specialist
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Current Medications (Name, Dose, Reason - Hit Return after Each Medication)
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Medication or Seasonal Allergies (After each one hit return)
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Your Behavioral Health History

Provide the Name And Address For Counselors Seen. Hit Return after Each Counselor.
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Current Medications (Name, Dose, Reason - Hit Return after each Medication)
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Have you ever attended or experienced:
Have you ever been:

Your Legal History

Other Information

Marital History and Children for this Case

Status
Children (Check All That Apply)
Children(s) Names, Sex, DOB and Ages With This Partner (Hit Return After Entry for Each Child)
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Partners Children and Ages From Other Relationships (Hit Return After Entry for Each Child)
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Describe the history of your relationship with the parent of the children involved in this case, starting with the beginning. For each event, enter the year and what took place. (Hit Return after each event).
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If Yes, Please Provide Each Person's Name(s), Address(es), Phone and Role (Hit Return after Entry for Each Person)
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Prior Marriages or Partnerships

Your Children(s) Names(s) and Age(s) From Prior Relationships (Hit Return After Entry for Each Child)
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Partner Name(s) and Marriage Date(s) For Prior Relationships (Hit Return After Entry for Each Child)
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Current Marriage or Partnerships

Your Children(s) Names(s) and Age(s) From Your Current Relationship (Hit Return After Entry for Each Child)
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Partner Name(s) and Marriage Date(s) For Your Current Relationship (Hit Return After Entry for Each Child)
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Your Case

I certify that I have completed this form accurately, to the best of my ability and without the assistance of others. (You will be asked to sign this form at your initial meeting).

Signature (Use Mouse or Similar) *
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©  2014 James Davidson Ph.D.