Parenting/Custody Support Intake

  • Parenting/Custody Support Intake

    Please complete this intake form so we can assess your situation and provide guidance. Answer all applicable questions, and use “Please specify:” whenever you choose “Other.”

  • Client/Parent 1 Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Preferred Method of Contact*
  • Living Situation*
  • Household Members*
  • Driver’s License Status*
  • Access to a Vehicle*
  • Primary Transportation Methods*
  • Government Assistance*
  • Physical Health Concerns*
  • Mental Health Concerns*
  • Substance Use History*
  • Criminal History*
  • CPS-DSS History*

  • Parent 2 Information

    This information is only to insure there is not conflict of interest and to get a better idea of your case. It will not be used otherwise.
  • Date of Birth
     - -
  • Living Situation
  • Household Members*
  • Driver’s License Status*
  • Vehicle Access*
  • Primary Transportation*
  • Employment Status*
  • Receives Government Assistance*
  • Types of Government Assistance
  • Physical Health*
  • Mental Health*
  • Substance Use*
  • Criminal History*
  • CPS-DSS History
  • Role in the Child’s Life*

  • Child(ren) Information

  • Please complete one set of child information for each child listed above.
  • Child 2 Date of Birth
     - -
  • Child 2 Services Received

  • Legal/Custody Situation

  • Is there a current court order or custody agreement in place?*
  • What is the current parenting arrangement?*
  • Is there any current court involvement or ongoing case?*

  • Safety Concerns

  • What safety concerns, if any, apply?
  • Is there any immediate risk of harm right now?

  • Goals / What the Client Is Seeking

  • What would you like help with?*
  • What type of custody or parenting-time outcome are you seeking?
  • Which support services are you interested in?

  • Which service(s) are you interested in?

    Please select all services you are interested in learning more about. You may select multiple.
    • Parenting Plan Development 

    • Child-focused parenting plan support designed to help families create clear, realistic agreements for custody, schedules, communication, and decision-making.

      Sliding scale pricing is available to help make support accessible for families at different income levels.

      Services may include but not limited to:

      • Custody and visitation schedules
      • Holiday and vacation planning
      • Transportation arrangements
      • Communication expectations
      • Decision-making provisions
      • Safety and transition planning
      • First right of refusal language
      • Step-up plans when appropriate

      Each parenting plan includes one month of Tier 3 Support

      Parents on Medicaid please review Tier 1

    • Tier 1 — Medicaid / Extreme Hardship 

    • $25 per month


      Designed for parents experiencing significant financial hardship who still need ongoing support navigating family court and coparenting challenges.

      Includes:

      • Free intake interview
      • Parenting plan support
      • 1 hour of evidence review per month
      • Unlimited texting during business hours
      • Biweekly 30-minute check-in meetings
    • Tier 2 — Standard Support 

    • $50 per month


      Ongoing support for parents preparing for court, mediation, or navigating ongoing coparenting concerns. This tier is designed to help clients stay organized, focused, and prepared throughout their case.

      Includes:

      • Free intake interview
      • Up to 3 hours of evidence review per month
      • Unlimited texting during business hours
      • Monthly progress summary
      • Biweekly 30-minute meetings
      • Ideal for families preparing for court or mediation.
    • Tier 3 — Comprehensive Support 

    • $75 per month

      Designed for families navigating high-conflict or ongoing family court matters that require consistent organization, communication support, and case management assistance.

      • Includes:
      • Free intake interview
      • Up to 5 hours of evidence review per month
      • Unlimited texting during business hours
      • Chronology/timeline creation
      • Priority review turnaround
      • Weekly 30-minute check-in meetings

       

      Best for high-conflict or ongoing cases needing consistent organization and support.

    • Free Support & Resource Services 

    • Threshold Advocacy Group also offers limited free support services and community resources for families navigating difficult situations. Availability may vary based on volunteer capacity and current demand.

      Free services may include:

      • Support Groups
      • Referrals to attorneys, therapists, evaluators, and community resources
      • Assistance locating local support services
      • Community support and advocacy resources

        These services are intended to provide education, support, and direction for parents who may not yet need ongoing monthly services.

  • Confidentiality & Privacy

  • Threshold Advocacy Group is committed to protecting your privacy.

    All information you share with us will be kept confidential and used solely for the purpose of providing support, guidance, and advocacy-related services. We do not share your information with third parties without your consent.

    However, please note that confidentiality is not absolute. There are limited circumstances where information may be disclosed, including but not limited to:

    • Compliance with a valid court order, subpoena, or other legal requirement within reason
    • Situations involving credible threats of harm to yourself or others
    • Circumstances where disclosure is required by law

    Threshold Advocacy Group provides legal coaching and advocacy support and is not a law firm. Communications with our organization are not protected by attorney-client privilege.

    By proceeding, you acknowledge and understand the limits of confidentiality as described above.

  • How did you hear about Threshold Advocacy Group?

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