REQUIRED DOCUMENTS WHEN THERE IS A CUSTODY ORDER

Our practice strives to uphold the highest ethical and legal standards. Our policy regarding custody and consent to treatment is based on rulings by the Pennsylvania State Board of Psychology and guidance from the Pennsylvania Psychological Association.

It is our policy that, for children ages 13 and younger, all individuals with legal custody of the child must consent to the services and complete a pre-intake packet. This must be done before the first appointment is scheduled. Children 14 and older may consent to therapy or evaluation on their own behalf.

This policy applies when:

  • The child’s biological or adoptive parents are divorced.
  • There is a custody order involving the child, for any reason.
  • When the child is in the custody of Children & Youth Services and is in a kinship or foster placement.

If you have sole legal custody

Sole legal custody means that one parent has been granted the right to independently make all decisions about a child’s well-being, such as decisions about education and healthcare, without involving the other parent. This is unusual. Legal custody is not the same as physical custody, which has to do with where a child lives and the visitation arrangement with other caregivers.

If you have sole legal custody, we will need the following before the first appointment is schedule:

  1. a copy of the custody order
  2. Agreement for Court-Involved Families (if there is a current or anticipated custody dispute)

Options for submitting the required documents are listed at the bottom of this page.

If you have shared legal custody

If there is a custody order granting shared legal custody to two or more parents or guardians, we require the following:

  1. a pre-intake packet be signed by each adult listed in the custody order
  2. a copy of the custody order (if the guardians include anyone besides the child’s parents)
  3. Agreement for Court-Involved Families (signed by all parties, if there is a current or anticipated custody dispute)

The parent/guardian requesting the appointment may complete the pre-intake paperwork through our Client Portal or arrive early at the first appointment to sign it. All other parents/guardians will need to complete a paper copy of the pre-intake packet and return it to our office. The packet can be downloaded below.

Pre-Intake Packet – Medical Assistance

Pre-Intake Packet – All Others

Once we have received the required paperwork, our Client Care Coordinator will contact the parent/guardian who initiated the request for services to schedule an appointment.

How to submit required documents / pre-intake packet

There are three options for sending the required documentation / paperwork to us:

  1. Fax to (717) 620-0536
  2. Email to ClientCare@CampbellPsychPA.com – Please consider limits to privacy/security when sending sensitive information by email
  3. Mail to: Campbell Psychological Services, Attn: Client Care Coordinator, 25 E North Street, Carlisle, PA 17013