IN THE CIRCUIT COURT IN THE EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA. Case No.: Bar Code Label IN RE: The Marriage of __________________________________, Husband and , Wife ORDER DIRECTING PSYCHIATRIC/PSYCHOLOGICAL EVALUATION THE COURT having considered the Motion for Psychological Evaluation, it is hereby: ORDERED AND ADJUDGED that: 1. This psychologist/psychiatrist shall conduct a psychological evaluation of the parties and the child(ren) as soon as is expediently possible: Name___________________________________ Address_________________________________ City, State, Zip____________________________ Telephone No.____________________________ 2. The evaluation shall concentrate on the following issues: [ ] Parental responsibility [ ] Visitation and contact [ ] Relocation [ ] Primary residence(s) if child(ren) [ ] Abuse allegations [ ] Other (specify):_______________ ____________________________ 3. The parties or their counsel shall immediately contact the court-appointed psychologist/psychiatrist to assure scheduling for their clients and the minor child(ren). 4. The original report shall be filed with the Court, and a copy furnished to the attorney for each party. Law 1043- Rev. 10/2005 American LegalNet, Inc. www.FormsWorkflow.com ORDER DIRECTING PSYCHIATRIC/PSYCHOLOGICAL EVALUATION Page 2 5. Case No______________________________ The Court determines payment for such psychological/psychiatric evaluations as follows: The [ ] Husband [ ] Wife shall pay the cost of his/her evaluation and, The [ ] Husband [ ] Wife [ ] both shall pay the costs for the child(ren)’s evaluations. [ ] The costs of these evaluations shall be allocated by the Court according to the relative incomes of each of the parties. [ ] The cost for each evaluation should not exceed $____________. DONE AND ORDERED in Brevard County, Florida, on {date} ________________________, 20____. ____________________________________ Circuit Judge Copies furnished to: All counsel of record or pro se parties Psychologist/Psychiatrist Law 1043- Rev. 10/2005 American LegalNet, Inc. www.FormsWorkflow.com