FORM 5.7 Petition for Physical and/or Mental Examination

IN THE COURT OF COMMON PLEAS

OF __________________ COUNTY, PENNSYLVANIA

PLAINTIFF : No.

v. :

DEFENDANT

: IN CUSTODY

PETITION FOR PHYSICAL AND/OR MENTAL EXAMINATION

AND NOW, Plaintiff, by and through [his/her] attorney, __________________, Esquire, files a Petition for

Physical and/or Mental Examination, and in support thereof, avers the following:

1. Plaintiff is __________________ [Mother/Father], who currently resides at __________________.

2. Defendant is __________________ [Mother/Father], who currently resides at __________________.

3. The parties hereto are the parents of the following minor [child/children], who currently reside(s) at

__________________.

4. On __________________, 20______, [Mother/Father] filed a Complaint for [Custody/Partial

Custody/Visitation] in the Court of Common Pleas of __________________ County, Pennsylvania.

5. The above-captioned custody action involves consideration of the mental and/or physical condition of

[Mother/Father] and/or [the child/children]. It is in the best interests and welfare of the [child/ children] that

[Mother/Father/child/children] be ordered to submit to a physical and/or mental examination by a [physician and/or

psychiatrist/psychologist]. Since the mental and/or physical condition of [Mother/Father] and/or [the child/children] is

in controversy, there is an affirmative duty to develop a record and to conduct a thorough investigation with the aid of

outside experts.

6. The cost of such examinations shall be paid as ordered by the Court.

WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter an Order of Court pursuant to Pa.

R.C.P. 1915.8 directing [Mother/Father] and/or [the child/children] to submit to a physical and/or mental examination

by a [physician and/or psychiatrist/psychologist] [specify the time, place, manner, conditions and scope of the

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examination and the person or persons by whom it is to be made]. It is further requested that the examining [physician

and/or psychologist/psychiatrist] 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 and/or conference on the merits of this case.

Respectfully submitted,

__________________

, Your Name

[Verification]