FORM 104.10-5 Petition for Mental Examination of Parties and Child



__________________ by and through his/her attorneys, __________________, brings this, his/her Petition for a Mental Examination of Parties and/or Child pursuant to Rule 1915.8 of the Pennsylvania Rules of Civil Procedure and avers as follows:

1. Petitioner is __________________, an individual residing at __________________.

2. Respondent is __________________, an individual residing at __________________.

3. The parties __________________, are the natural parents of __________________, age ______.

4. The custody of __________________ is the subject matter of this litigation.

5. The above-captioned custody action involves consideration of the mental and/or physical condition of mother/father and/or the child(ren). It is in the best interests and welfare of the child(ren) that mother/father/child/children be ordered to submit to a physical and/or mental examination by a physician/psychiatrist/psychologist (specify the time, place, manner, conditions and scope of the examination). It is further requested that the examining physician/psychiatrist/psychologist shall deliver to this Honorable Court and to the attorneys of record copies of a detailed written report setting out the findings, results of all tests made, diagnosis and conclusions no later than ten (10) days prior to the date of a hearing/conference on the merits of this case.

6. Petitioner believes and therefore avers that the costs of the examination and report should be equally shared by the parties.

WHEREFORE, Petitioner respectfully requests this Honorable Court to:

a. Order the mother/father/child(ren) to appear before a physician/ psychiatrist/psychologist of the Court's choosing.

b. Order the parties to equally bear the costs of said examination and report.

c. Such other relief as is necessary.

By: ________________________