Custodial Consent Parent Custodial Consent_Parent (2-5) X/TwitterThis field is for validation purposes and should be left unchanged.Custodial Consent for Psychological Testing We are committed to ensuring the best care and support for your child. To comply with legal and ethical guidelines, we require documentation regarding the custody and consent arrangements for psychological testing. Please complete the following information and provide any necessary legal documents. Child’s InformationName of ChildDate of Birth MM slash DD slash YYYY Parent/Guardian InformationName of Parent/Guardian 1Relationship to ChildContact InformationName of Parent/Guardian 2Relationship to ChildContact InformationCustody Information Please provide details about the custody arrangement for the child. Attach a copy of the custody agreement or divorce decree if applicable.Type of Custody ArrangementIs joint consent required for medical and psychological services? (Yes/No)Please Make SelectionYesNoConsent I/We, the undersigned, certify that the information provided above is accurate and complete. I/We understand that both parents/guardians may need to provide consent for psychological testing. By signing below, I/we authorize the psychological testing of the above-named child and confirm that all necessary consents have been obtained.Signature of Parent/Guardian 1Date MM slash DD slash YYYY Signature of Parent/Guardian 2Date MM slash DD slash YYYY
