Short Form Child Custody/visitation Evaluation Report printable pdf download

SHORT FORM CHILD CUSTODY/VISITATION EVALUATION REPORT

(The examples in this form are for illustrative purposes and are not

designed to limit findings and opinions of the mental health professional)

To: Court and All Attorneys of Record

1) This examiner has had the following contacts with the parties and the children in this matter and has

administered the following tests:

Party 1 - Name ____________________________; Relationship to child __________________

_____ individual session(s)

_____ joint session(s) with ___________________________________________________

Other type contact: _________________________________________________________

Types of Test(s) Administered:

Test 1 ______________________; valid profile: Y or N (circle one)

Test 2 ______________________; valid profile: Y or N

Test 3 ______________________; valid profile: Y or N

Party 2 - Name ____________________________; Relationship to child __________________

_____ individual session(s)

_____ joint sessions with _____________________________________________________

Other type contact: __________________________________________________________

Types of Test(s) Administered:

Test 1 ______________________; valid profile: Y or N (circle one)

Test 2 ______________________; valid profile: Y or N

Test 3 ______________________; valid profile: Y or N

Child 1 - Name _______________________________________________________________

_____ individual session(s)

_____ joint sessions with _____________________________________________________

Other type contact: __________________________________________________________

Types of Test(s) Administered:

Test 1 ______________________; valid profile: Y or N (circle one)

Test 2 ______________________; valid profile: Y or N

Test 3 ______________________; valid profile: Y or N

Child 2 - Name ________________________________________________________________

_____ individual session(s)

_____ joint sessions with _____________________________________________________

Other type contact: __________________________________________________________

Types of Test(s) Administered:

Test 1 ______________________; valid profile: Y or N (circle one)

Test 2 ______________________; valid profile: Y or N

Test 3 ______________________; valid profile: Y or N

Short Form Child Custody/visitation Evaluation Report