Short Form Child Custody/visitation Evaluation Report (Page 2 of 2) in pdf

2) Other sources of information:

I have reviewed the following documents (example: report cards, medical records):

____________________________________________________________________________

I have spoken to the following persons concerning the subjects detailed below:

Name: ______________________________ Subject Matter: ___________________________

I have been unable to obtain the following information that would be relevant to the issues in this matter:

___________________________________________________________________

3) Identify any specific facts or state any specific opinions regarding the parties or the children that may

impact the issues before he court.

Party 1:

Functioning:__________________________________________________________

Facts: ______________________________________________________________

______________________________________________________________

Party 2:

Functioning:__________________________________________________________

Facts: ______________________________________________________________

______________________________________________________________

Child 1:

Functioning:__________________________________________________________

Facts: ______________________________________________________________

______________________________________________________________

Child 2:

Functioning:__________________________________________________________

Facts: ______________________________________________________________

______________________________________________________________

4) Specific recommendations, if any, in light of the opinions or facts set forth in 3.

A. _________________________________________________________________________

_________________________________________________________________________

B. _________________________________________________________________________

_________________________________________________________________________

C. __________________________________________________________________________

_________________________________________________________________________

D. _________________________________________________________________________

_________________________________________________________________________.

Signed: ________________________________________________ Date: ________________

Short Form Child Custody/visitation Evaluation Report Page 2