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 Printable
ORDER FORM
GRAPHOANALYSIS SERVICES
Request and Authorization Statement
*I request and authorize a Graphoanalysis Evaluation to be completed based on my
handwriting.
(I understand signature(s) below, release the analyst of
any liability based upon findings or recommendations.)
_______________________________
_____________________________
Name (Please Print) Signature
_____________________________________
___________________________________
Street Date
_______________________________________ ___________________________________
City
State Zip E-Mail Address (Optional)
________________________________________________________________________________________________________________________________________
Please circle Service requested from listing below.
1. PROFILE GRAPHOANALYSIS - $30
5. COMPREHENSIVE GRAPHOANALYSIS - $250
2. GENERAL GRAPHOANALYSIS - $80
6. COMPREHENSIVE JUVENILE REPORT - $250
3. GENERAL COMPATIBILITY REPORT - $160
7. VOCATIONAL GRAPHOANALYSIS - $350
4. BUSINESS GRAPHOANALYSIS - $180
8. QUESTIONED DOCUMENT WORK - (See Schedule)
________________________________________________________________________________________________________________________________________
Instructions: In the space provided below please compose or copy a
full paragraph in your own cursive handwriting, using a writing instrument that
is comfortable for you.
If desired, continue writing on back of form.
The more
writing submitted, the more accurate the analysis. Please indicate if you are
right-handed ___ or left-handed ___. A Graphoanalysis Evaluation will be prepared based on this handwritten specimen.
HANDWRITING SPECIMEN PARAGRAPH
*Please note
- If writer is under age 18, Parent Approval/Signature is required as follows:
“I hereby extend permission for a Graphoanalysis to be completed based on the
handwriting of
Child's Name________________________.” Parent Signature:
__________________________Date:__________
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