Supervised Visitation Report Request
Submit your details and any supporting order or written request to request a factual supervised visitation report.
Requester Information
Requester Full Name
*
First Name
Middle Name
Last Name
Requester Role
*
Visiting Parent
Custodial Parent
Attorney
Social Worker/Caseworker
Guardian/Caregiver
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Case and Child Information
Family Surname or Case Name
*
Court Case Number
*
Court County
*
Child Name(s)
*
Visit Details
Visit date or date range requested
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is this request for one specific visit or multiple visits?
*
One specific visit
Multiple visits
Request Purpose and Timing
Reason for Request or Intended Use
Upcoming Court Date or Deadline
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Payment and Recipient Details
Who is Responsible for Payment?
*
Requester
Agency
Court
Other
Report Recipient(s) and Email/Contact Information
*
Upload Court Order, Subpoena, or Written Request (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Acknowledgment and Signature
Reports are factual and limited to direct observations and direct statements. They do not include custody recommendations, diagnoses, therapy opinions, investigative conclusions, legal opinions, or recommendations concerning future visitation. The standard fee is $65 per report unless another written arrangement applies. Standard turnaround is 5–7 business days unless otherwise required or agreed. Submitting this form does not guarantee acceptance or a particular completion date. Distribution follows the court order, California Standard 5.20, and applicable law regardless of who requests or pays.
I acknowledge and agree to the statements above.
*
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
Submit Request
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