Please enable JavaScript in your browser to complete this form. Psychosexual Evaluation – Risk Evaluation The Forensic Evaluation Program at Bevill and Associates LLC located in Birmingham, AL offers a range of assessment and treatment to address the needs of individuals with sexual behavioral problems including sexual offenses and sexual victimization. Client Name *FirstLastDate of Birth *Sex *MaleFemalePrimary Spoken Language *Email *Phone *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDescription of Charges or Allegations Court Jurisdiction: StateFederal*Criminal and Custody Cases Only Legal Status:Any Current RestrictionsReferral Request – Type of EvaluationPsychosexual Evaluation (Criminal in Scope)Psychosexual Evaluation (Child Custody in Scope)Psychosexual Evaluation (Professional Licensing Board or Employer)Attorney / Licensing Board / Referral SourceName *FirstLastName of Law Firm / Board/ Employer/ Court: *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Financial – Responsible PartyThe fee for this evaluation is $2000, the evaluation fee must be paid prior to the start of the evaluation, unless a third party such as the court has agreed to pay for the evaluation. If the evaluation or any part of the evaluation is preformed outside the office of Bevill and Associates LLC, the responsible party is responsible for the milage expense at a rate of $.65 per mile. All fees must be paid in secured funds (certified check, money order or credit card) a 3.75% processing fee will be applied to all credit card charges. If a third party is paying for the evaluation, then this third party must sign a financial agreement before the evaluation begins. Expert testimony in court, conferences with attorneys, court officials, licensing boards, and telephone consultation about the report will be charged at $200 per hour. If you plan to call your therapist or evaluator as an expert witness in your case, then you will need to pay a retainer fee in advance, which will cover 5 hours of services. This would be $1,000 for 5 hours and additional hours will be billed at $200 per hour. SignatureClear SignatureYour signature indicates that you have read and understand the above-stated conditions. Date *Name *FirstLastAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneInformed Consent For Testing and Evaluations Purpose of the Evaluation: Bevill and Associates LLC will conduct an evaluation to examine your psychological and sexual functioning. This will include your background and family history, psychological adjustment and sexual history. This evaluation serves the court, in its consideration of possible innocence, potential risk to public safety, need for specialized treatment and/or sentencing alternatives. Pre-trial investigative officers have found these types of reports to be useful in making recommendations to the court. The report can also enable defense attorneys to argue effectively for appropriate treatment for their clients. Tests / Assessments Used: You will be administered a battery of psychological and psychosexual, as part of the evaluation process. Those tests will include some or all of the following: Psychosexual Interview: You will be interviewed regarding your sexual history and family history as related to your current problem. Additional information will be gathered from court records and other sources as needed. It is always recommended that you bring in a copy of any court documents that you have pertaining to your case! Psychological and Sexual History Questioner: is a comprehensive assessment of an individual’s sexual history. It is specifically created to assess male offenders and help evaluate the offender’s risk to others and his potential for rehabilitation by determining his specific sexual experiences. Multiphasic Sex Inventory: This questionnaire assesses the psychological characteristics of individuals with a sexual deviancy problem or those who have been accused of inappropriate sexual behavior. It is a sex inventory, not a personality test. It is not appropriate for use in the legal determination of guilt or innocence. The alleged offender must acknowledge guilt in order for the inventory to be most useful. This test compares the responses of the individual to known groups of individuals who have displayed inappropriate sexual behavior. It provides important information regarding the nature of the offense and the individual’s characteristics. It can also be used during the treatment process to determine the degree of openness and progress in treatment. While the MSI does not tell us whether an individual is likely to commit deviant sex acts, it does help in determining the confidence we might wish to place in the individual’s self-statements regarding his actual intent and behavior with regard to sexually deviant activities. Minnesota Multiphasic Personality Inventory -2 (MMPI -2): This is a widely used test of personality characteristics. This questionnaire contains 567 true/false items. The test results yield a profile for each client, which gives information about the client’s personality and any psychiatric symptoms. This test has scales to detect faking. Multiaxial Diagnostic Inventory: This is a form that lists various problems and symptoms. You are asked to check any of these that apply to you. The ABEL Assessment for Sexual Interest: is an instrument used to measure sexual interest. The ABEL is a non-invasive computerized test that takes about 2 hours to complete. This instrument will assist in determining various treatment issues including: Separating those who have no interest in children from those who deny interest. Dangerousness (sadistic interest in violence vs. opportunistic offending). Violence to children Arousal to children Uses of the testing / Assessments: The overall purpose of the testing is to help identify your potential psychological or sexual problems, if any. The test data is used in the following ways: 1) To help develop an understanding about your behaviors and psychological problems that may relate to sexual deviancy. 2) To help develop ideas about any sexual problems you may be experiencing such as sexual desires, obsessions, difficulties, sex knowledge, and deviant or atypical sexual behaviors. 3) To report your need for treatment or treatment progress to the appropriate agency, referral source, attorney, probation officer, court, etc. 4) The testing may be used to provide ongoing research data to help better understand individuals who may have sexual and/or psychological problems. Any data that may be used will not be linked personally to any client. All data will be coded with assigned research numbers rather than names. If you would not like to have your data used, then please notify your evaluator who will ensure that it is not used. I understand that by signing this Informed Consent Form, I agree to all terms and conditions contained herein and hold harmless the Sexual Deviancy Program and Bevill and Associates LLC. I also understand that no test results will be released from this clinic without my express written consent. If you would like for the test results to be released, please fill in and sign the Release of Information form attached. My signature below indicates that I have read and understand the above-stated conditions of testing, payment, and information release. Signature *Clear SignatureYour signature indicates that you have read and understand the above-stated conditions.File Upload Click or drag files to this area to upload. You can upload up to 5 files. Discovery or other relevant documents Payment OptionCredit Card Optional Payment Psychosexual Evaluation – $2,000.00Credit Card Processing Charge 3.75% – $75.00Stripe Credit CardCardName on CardEmailSubmit