For what it's worth, here's the consent form I used before I retired about ten years ago as a private examiner when examining criminal defendants referred to me by their attorneys.  The lines following each paragraph are for the examinee's initials to indicate he has read and understands everything.  Obviously a different form was used with sex offenders or others who were required to take the test.

Defense cases
POLYGRAPH CONSENT FORM

I, _____________________________________, hereby agree to take a polygraph examination to be conducted by Gordon H. Barland, Ph.D.  My initials following each paragraph indicate I understand that:

1.      The test is strictly voluntary.  I am not required by any law to take the test, and if I tell Dr. Barland I do not wish to be examined, he will not conduct the test.  If I do decide to take the test, which will take about 4 hours, I understand I am free to leave whenever I wish, even without having completed the examination.   _______

2.      There are no trick or surprise questions on the polygraph.  All questions to be asked on the polygraph will be explained to me before the polygraph is turned on.  I must approve each question before it can be asked on the polygraph.  I do not have to answer any question I don’t want to.                                          _______

3.      The polygraph is not infallible.  The results are inconclusive in about 10% of the cases; that is, the examiner may not be able to make a definite decision about my truthfulness.  In those cases where the examiner can make a definite decision, most examiners believe the accuracy is about 90%, with an error rate of about 10%.  Not all authorities agree on these figures.  Some think it is unscientific and doesn’t work at all, others think it is 95% accurate.  Nonetheless, I understand there is always a realistic chance of error.  I further understand that Dr. Barland is regarded as an expert on lie detection, and that he will do everything in his power to conduct as fair and accurate a test as possible.                                                                  _______

4.      Recording:  The entire examination is being digitally recorded, both audio and video.  This protects me against any misunderstanding as to what I said or how Dr. Barland conducted the examination.                        _______

5.      Complaints:  Unless it represents gross negligence or willful wrong, I agree not to sue Dr. Barland for any omission or act arising out of or attributed, directly or indirectly, to the administration of this examination.  If I have any reason to believe that the examination was not conducted completely impartially, fairly or professionally, I am aware that I can report it to the State of Utah’s Division of Occupational and Professional licensing.  They are responsible for licensing and regulating all polygraph examiners in Utah, and disciplining any infractions. ______

6.      Confidentiality:  I authorize Dr. Barland to release his report about this examination to my attorney, [ deleted ], Esq.  His report may include whatever I tell him, plus his opinion about whether I was being truthful or deceptive.  His report will go only to my attorney unless I or my attorney instruct him to release it to a third party, or unless he is compelled by law to provide it to a third party.                                    _______

I hereby indicate my willingness to be examined by Dr. Barland by signing below.


     Signature: ___________________________________  Date: ______________      Time:   ______________







Now that this test is finished, I acknowledge that while I was with the examiner, I was not subjected to any threats, injury, promises, or mental, physical or sexual abuse.  I further acknowledge that I was told how the test turned out, and was given an opportunity to provide an explanation for any question on the test to which I may have demonstrated physiological responses.

     Signature: ___________________________________  Date _______________      Time: ______________