Community Mental Health Services : Juror Inquiry Contact Form

Juror Inquiry Contact Form

Contact Information

Please make sure you have filled in all required fields with valid information.

Juror First Name:

Juror Last Name:

Juror Email:

Juror Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Date of Birth:

Juror Information

Please make sure you have filled in all required fields with valid information.

Date of Contact:

Referral Source:

WCU Website Jury Page
Jury Commission QR Code
Other

Referral Source - Other:

County:

Approx. Date Served:

Trial Type:

Criminal
Civil

Criminal Charge:

Criminal Charge - Other:

By agreeing to receive Jury Support Services, you acknowledge and understand that these services do not constitute mental health treatment. Participation in the Juror Support Program does not establish a clinical relationship with CMHS or any of its providers, or any affiliation, involvement, or connection with the Judiciary of the Commonwealth of Pennsylvania.