PASS: PROBATIONARY

PROBATIONARY TESTING

Name: *

Email: *

Subject: *

Message: *

REFERAL / REQUEST FORM

Please complete the form below. We will contact you to verify we have received your referal submission. By submitting this form you agree to the following below:

To appear at the PASS office during posted business hours.
- Hours are Monday - Friday 6:00 - 8:30 AM and from 6:00 - 8:30 PM;
  - Saturday and Sunday 6:00 - 8:30 AM ONLY.
To arrive 30 minutes before closing time for the initial intake / screen.
To bring picture ID for the initial intake / screen.
To pay for all services rendered prior to being screened. We accept cash, debit card, and credit card.
To bring proof of any prescriptions.
To comply with all conditions of PASS screening program
That you understand if you do not comply, the court or referring agency will be notified immediately.

Please include the following information in your message below:

Client / Defendant Name
Client / Defendant Date of Birth
Client / Defendant Phone Number
Probation Officer / Referring Agent Name
Judge / Court / Referring Agency
Probation Officer / Referring Agent’s Phone Number
Current Offense
Case Number
Date to begin Program
Other Reporting Requirements / Comments