Parenting Coordination Intake Form

Parenting Coordination Intake Form
This intake form takes about 10 minutes to complete and provides your Parenting Coodinator with some basic background information for the purposes of administration and preparation. The information collected is treated in the strictest of confidence and is not shared with the other party. However, due to the non-confidential nature of Parenting Coordination, the information may be requested by the Court for any possible ongoing or future litigation.

Please have any relevent Court Orders or Parenting Plans ready to upload.

Should you have any questions or require any assistance, please do not hesitate to call our team on 1300 164 164 or email us at admin@separationsolutions.com.au
Please select your Parenting Coordinator*

Personal Details
Name*

PrefixFirst NameLast Name
Email*
example@example.com
IMPORTANT: Please note this email address will be used in communications from us and your Parenting Coordinator to the other party. If you do not wish the other party to have this email address, please nominate an alternate address.
Phone number*
Please enter a valid phone number.
Age*
Occupation*
Full name of other party*

PrefixFirst NameLast Name
Do you currently have legal representation?*

YesNo
Legal representative's full name*

PrefixFirst NameLast Name
Firm name*
Legal representative's email*
example@example.com
Legal representative's phone number*

Details of children*

Safety & Risk
Are there any current allegations of risk to a party or child in the case?*

NoYes
Please specify the nature of the allegations.*
Are there any current ADVO or protection orders in place between the parties?*

NoYes
Who are the protected persons?*
What is the expiry date of the current ADVO or protection order?*
In the past 6 months, have you in any way been frightened of, or concerned for your own safety because of the other party?*

NoYes
Are you currently afraid for your own safety because of the other party?*

NoYes

Additional information
What do you consider are the issues that need to be addressed through Parenting Coordination?*
Are there any other relevant factors or information that you wish the Parenting Coordinator to be aware of?
Should be Empty:

Personal Details