Custody Evaluation Questionnaire Template Page 22
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If Yes, to any of above about alcohol/drug use, please give
information about first use, how long you used, and last use.
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Psychotherapy including Marital Therapy: (reasons for treatment,
names and phone numbers for psychotherapists, and dates of
treatment)
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History of Arrests (for whatever reason), DUI violations, Criminal
Prosecution, Dishonorable Discharge from Armed Forces (If there is
a history of any of the above, provide police, court, DMV,
probation, discharge records)
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