West. Cnty. Pa. 575
A petition requesting a competency evaluation shall contain a verified statement, in a form substantially similar to the one set forth below, indicating whether the defendant has or has not submitted to a competency evaluation in the past and shall set forth, to the extent known, the date on which such evaluation was performed. In the event that the petitioner has been the subject of a prior competency evaluation, he or she shall set forth reasons that another exam is warranted.
______________________________________________________________
STATEMENT AS TO PRIOR COMPETENCY EVALUATION
Petitioner [] has OR
[] has not undergone a prior competency evaluation.
Date of prior evaluation: _________________________________________________
Defendant requires an additional competency evaluation for the following reasons:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
I hereby verify that the information provided above is true and correct to the best of my knowledge, information and belief.
_____________________________
Counsel for Petitioner
West. Cnty. Pa. 575