Parenting Intake Form
Thank you for completing this confidential form, it will allow me to better understand your needs at mediation.
Name
First Name
Last Name
E-mail
Phone number
If you have a lawyer, what is their name and the firm they are from?
What are your children's names, ages and schools/daycare they attend?
How long was your relationship or marriage?
How have you coped with separation?
What is the co-parenting relationship like now?
What are the current parenting arrangements?
What is your ideal parenting agreement be after mediation?
Do you or your children have any cultural or language considerations I should be aware of?
Do you have any mental health or addiction concerns?
Does the other parent have and mental health or addiction concerns?
Have you or the children received any counselling or other professional assistance?
Are there any parenting plans, court orders, domestic violence orders or protection orders in place?
Submit
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