Custody Case Inquiry Form
Our agency can be held on retainer for custodial cases. We will supervise visits at an additional rate and provide support as needed.
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Custodial Party Parent/Guardian Name
First Name
Last Name
Custodial Party's Relationship to the children
Custodial Party's Phone Number
-
Area Code
Phone Number
Custodial Party's Address (If you are unsure, please input the general location)
How many children are involved in this case?
*
Please Select
1
2
3
4
5
6
1. Child Name
First Name
Last Name
1. Child's Age
2. Child Name
First Name
Last Name
2. Child's Age
3. Child Name
First Name
Last Name
3. Child's Age
4. Child Name
First Name
Last Name
4. Child's Age
5. Child Name
First Name
Last Name
5. Child's Age
6. Child Name
First Name
Last Name
6. Child's Age
Which best describes your situation?
Court ordered supervised visitation
Ongoing custody or visitation dispute
Reintroduction or reunification visits after limited or no contact
Other, describe more below
Briefly describe your situation and how we can help. Include the basic facts of the your situation and any other information you would like us to know before we reach out to you.
Which services are you interested in?
Custody support services
Co-parenting class
Supervised visitation
Drug testing
Child exchange supervision
Unsure
Has either parent been separated from the child for a significant period of time?
Yes
No
If yes, please explain
How would you describe communication between parties?
Generally cooperative
Some disagreements
High conflict
We do not communicate
There is a no-contact order
Is there currently a court case related to custody?
Yes
No
Unsure
Please describe current legal custody situation. Include your attorney information and upcoming court dates.
Please upload any court orders or other pertinent documentation. (If you do not have at this time, please know that we will need this provided in order to get started)
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Please list any other children who are not involved in this case. For each child, provide their age, describe your level of contact with them, and indicate whether any custody arrangements are in place
How did you hear about us? (Google, attorney, friend or family, etc)
Submit
Should be Empty: