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Family Court Form

This assessment result will be presented to (check all that apply) ^*

Just for myself and/or my attorney (no court order) A family court judge/magistrate CPS (child protective services) A GAL (guardian ad litem) Adoption agency Family attorney A different authority requesting the assessment

Do you have a written court order from a family court judge or magistrate which specifies the assessment you are supposed to obtain? ^*

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(for faster service please send a copy to info@ndsbs.com)

What type of assessment did the judge/magistrate or attorney specify (check ALL that apply): ^*

Alcohol use only Alcohol & drug use (aka "substance abuse assessment") Mental health Anger management Domestic violence Psychological assessment Psychiatric assessment Intellectual disability

Is there another parent or family member alleging or accusing you of a alcohol, drug, or mental health problem and seeking to minimize or eliminate your parenting rights? ^*

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if “yes”, please explain the allegation briefly ^*

Is there a file or “case discovery” the judge possesses that has evidence (documents, photos, text history, law enforcement reports or photos, etc.) of a mental health or substance use disorder? ^*

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What date are you supposed to submit this evaluation to the authority by?

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NOTE: Child custody or safety-related assessments (e.g. custody, divorce, domestic violence, protection orders, etc.) may involve your evaluator spending extended time reviewing the court documents, interviewing the other parent, reviewing mental health history, etc., and therefore are priced on a case-by-case basis after we review the above information.

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