Refer a Client - Total Court Services | Ignition Interlock

Referral Type *

Other

Please specify below

Client/Offender/Defendant Information Section

Name *

Phone *

Date of Birth *

Address *

Country

City

State

Zip code

Referring Agency/Court/Department Information Section

Case Number *

Agency/Court/Department *

Name of person to whom client will report *

Phone *

Fax

Email *

Preferred method of contact

Order Information Section

Monitoring or testing must start before *

Duration of time for order (ex. 180 days) *

Service Requested *

SCRAM CAM + House Arrest Notes

Standard curfew will be set to: 10pm-7am daily. Please notate any other schedule permitted below.

SCRAM Remote Breath Monitoring Notes

Standard testing schedule will be 7am fixed, 12pm noon fixed, 5pm-8pm random, 10pm fixed. Please modify testing schedule as required below.

BI Soberlink SL2 Breath Monitoring Notes

Standard testing schedule will be 7am, 12pm noon, 6pm, 10pm. No random testing schedules. Client will be given a schedule of test times. Please modify testing schedule as required below.

SCRAM GPS Monitoring Notes

Please notate any exclusion zone addresses (with radius for each) and curfew (10pm – 7am standard if requested) required for monitoring below. Please notate any other schedule permitted below.

SCRAM House Arrest Monitoring Notes

Standard curfew will be set to: 10pm-7am daily. Please notate any other schedule permitted below.

Vehicle Immobilization Notes

Please notate any vehicle information available below.

Oral Fluid Drug Testing Notes

This is a standard 12-panel test. Please notate whether tests are to be fixed or random and the number of tests to be performed monthly below.

Transdermal Patch Drug Testing Notes

Please notate standard 5-panel, or expanded opiate specific testing below.

Upstreem GPS Notes

Please notate any exclusion zone addresses (with radius for each) and curfew (10pm – 7am standard if requested) required for monitoring below. Please notate any other schedule permitted below. PLEASE NOTE: Due to popularity availability may be limited. Allow for up to 5 business days for installation.

Omnilink GPS Notes

Service Notes/Additional information

Will this client's fees be paid for by the agency?

Yes

Notes Regarding Agency Pay

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Once submitted, please print the resulting order sent to your email and provide to the client/offender/defendant. Remind the client that they must call us immediately in order to set their appointment time. We will notify you if the client/offender/defendant has not contacted us within two-business days.