Family Law SmartMobile Enrollment Form

"* (required)" indicates required fields

Client Information

First Name* (required)

Last Name* (required)

Cellphone* (required)

Zip Code* (required)

Email* (required)

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State

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City

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Street Address

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Date of Birth

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Program Start Date

The client is required to pick up their device and begin the program by:

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Are you currently, or have you ever been, a client of Smart Start?

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How did you hear about Smart Start?

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Referral Name (if applicable)

Customized Test Windows

Use the fields below to set up a schedule that's specifically tailored for your client, with Scheduled or Random testing. You can specify up to 10 tests each day by clicking on the plus symbol on each line.

Default test windows will be set for 6AM to 8 AM, 12PM to 2PM, 5PM to 7PM, and 9PM to 11PM. To customize the testing windows please send an email to FamilyLaw@SmartStartinc.com with your client information and preferred test windows.

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Sunday

SUNDAY

Start

End

Timing

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Monday

MONDAY

Start

End

Timing

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Tuesday

TUESDAY

Start

End

Timing

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Wednesday

WEDNESDAY

Start

End

Timing

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Thursday

THURSDAY

Start

End

Timing

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Friday

FRIDAY

Start

End

Timing

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Saturday

SATURDAY

Start

End

Timing

Reporting Notifications

Choose up to four recipients to receive reports via email.

To set up reporting notifications please send an email to FamilyLaw@smartstartinc.com with your contact information provided above. Once received, a reporting information document will be emailed to you via DocuSign. When the completed document is received by a Smart Start representative, the reporting recipients will be added to your account.

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Monitoring Contacts

Name *

Address

Email *

Phone Number