Custody Evaluation Questionnaire Template Page 2
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272
C.
YOUR CHILDREN INVOLVED IN THIS CUSTODY CASE
Name
Age
Birthdate
____ School/Grade_____
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
YOUR OTHER CHILDREN (not involved in this court case)
Name
Age
Birthdate
____ School/Grade____
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Children’s Personality and Special Emotional or Physical Needs (For
each child involved in this case, describe your child as you would
to a stranger. Then discuss any physical or educational disability,
emotional or behavioral problems, history of psychotherapy or
psychiatric care, and special talents or interests that may affect
custody arrangements):
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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