CUSTODY INFORMATION

If you are seeking evaluation or treatment services for your child who is under age 14
and have a court-ordered custody arrangement for your child, the following forms must be
completed and returned to Associates of Springfield Psychological before we can schedule
an appointment for your child. Please note that Pennsylvania law allows children aged 14
and older to access evaluation and treatment without parental consent.

Please note that Associates of Springfield Psychological does not provide evaluation
services for use by a court to determine custody arrangements. We do provide
evaluation services to determine if treatment is appropriate.

If you have a custody arrangement which was determined by the court and it is not
working well for your child(ren), our mediators may be able to be of assistance.
Click on the link for Professional Mediation Associates for more information.

Please print the first two forms (located below) and fill them out. When appropriate,
the third form can be printed and completed as well. You may either drop them
off, mail them to our main office, or fax them.

Mailing Address
1489 Baltimore Pike
Bldg. 200, Ste. 250
Springfield, PA 19064

Fax Number
(610) 604-9510

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FORMS

Consent Form 1 | Consent Form 2 | Consent Form 3