Fillable Superior Court of California County of San Bernardino (Superior Court of California)

Fill Online, Printable, Fillable, Blank Superior Court of California County of San Bernardino (Superior Court of California) Form

Use Fill to complete blank online SUPERIOR COURT OF CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Superior Court of California County of San Bernardino (Superior Court of California)

On average this form takes 5 minutes to complete

The Superior Court of California County of San Bernardino (Superior Court of California) form is 1 page long and contains:

  • 0 signatures
  • 18 check-boxes
  • 12 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Superior Court of California forms online.

BROWSE SUPERIOR COURT OF CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
13-14455-360 Revised March 5, 2020
Superior Court of California
County of San Bernardino
247 West 3
rd
Street, 11
th
Floor
San Bernardino, Ca. 92415-0302
doctorpanel@sb-court.org
Agreement to Accept Orders of Psychiatric/Psychological Appointment
Name:
Email Address:
Address:
Phone Number:
City/State/Zip:
Fax Number:
CA. License Number:
I
agree to accept Orders of Psychiatric/Psychological Appointment from the Superior
Court, County of San Bernardino to conduct the following types of evaluations (please select the evaluation types you are willing to
conduct):
☐
PC1368/1369/1370 Competency Evaluation and Report
☐
PC1026/1027 NGI Evaluation and Report
☐
PC288.1 Sex Offender Evaluation and Report
☐
HS3050/3051 Narcotic Evaluation and Report
☐
EC1017 Defense-requested Evaluation and Report
☐
EC730 General Evaluation and Report
Please select the court district(s) where you are willing to accept appointments and provide testimony, if needed:
Please select to which of the following locations you are willing to travel:
☐
☐
☐
☐
☐
Please select the appointment type(s) you are willing to accept:
☐
Rush (10 days to submittal
☐
In custody
☐
Out of custody
Please list any foreign language abilities:
I understand that by accepting psychiatric/psychological appointments it is my responsibility to submit my report to the appointing
court within twenty (20) days, along with my invoice, of my appointment unless other arrangements have been made by me with the
appointing court.
I agree to accept appointments in accordance with the Court’s Appointed Service Fee Schedule rates currently in effect at the time
of my appointment by the court. I further certify that the above information and the attached curriculum value are true and accurate.
Signature:
Date:
PLEASE ATTACH YOUR CURRICULUM VITAE AND EMAIL TO doctorspanel@sb-court.org
☐
Joshua Tree
☐
Rancho Cucamonga
☐
San Bernardino
☐
Victorville
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Superior Court of California County of San Bernardino (Superior Court of California)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document