All Clients
These forms are required by all clients of Co-Parenting Solutions, LLC.
1. Intake Form*
2. Authorization for Teletherapy*
3. Consent for Therapeutic Treatment*
4. Credit Card on File*
5. Notice of Privacy*
6. Contract for Co-Parenting Counseling and Skill Building Sessions*
The purpose of Co-Parenting Counseling is to empower both parties to communicate and problem-solve more effectively with one another and not to utilize the Co-Parenting Counselor for ongoing litigation between parties. If being subpoenaed to testify in court, please remember that all testimony will be from a place of neutrality and not to bolster either party’s stance in litigation circumstances. The cost for services for testimony is a $500 retainer (non-refundable if the case settles and/or court is canceled for any reason). The cost for testimony is $1,500 for a half-day (1-3 hours) or $3,000 for a full day (3.5-7 hours) (the retainer of $500 will be applied to the additional). Any written letters requested from the Co-Parenting Counselor will start with a $250 retainer fee PLUS the hourly rate of $180/hour for the time taken to research, prepare and write the letter.
7. Authorization to Release or Exchange Information**
*Required form for all clients
**This form is required for anyone who is Court-Ordered to use our services, and optional for anyone using our services voluntarily. The use of this form allows us to speak to others that have involvement in your situation (e.g., child or personal therapist, attorney). Court-Ordered persons must authorize contact with court officials, and can optionally authorize contact with others involved (e.g., child or personal therapist, attorney). If you are court-ordered, be sure to include who you are working with through the court. If you don’t know their name, just give their title, such as Judge or FOC, and whatever county you are working with.
Court-Ordered Services
8. Contract for Court-Related Services
This form is required for families participating in our services through a Court Order or Consent Order signed through your attorney.
Parent-Child Reunification
9. Consent for Minor Therapeutic Treatment
Families participating in parent-child reunification services should fill out and sign this form.
If being subpoenaed to testify in court, please remember that all testimony will be from a place of neutrality and not to bolster either party’s stance in litigation circumstances. The cost for services for testimony is a $500 retainer (non-refundable if the case settles and/or court is canceled for any reason). The cost for testimony is $1500 for half-day or $3000 for full-day (the retainer of $500 will be applied to this). Any written letters requested from the Co-Parenting Counselor will start with a $200 retainer fee PLUS the hourly rate of $180/hour for the time taken to research, prepare and write the letter.
Collaborative Divorce
10. Collaborative Divorce with Mental Health Professional Agreement
This form is for those wishing to engage our services for assistance with collaborative divorce.
Divorce Mediation
11. Contract for Mediation Services
This form is required for those utilizing divorce mediation services.
12. Consent for In-Person Services During Covid-19 Public Health Crisis
Notice: Form checklist tracking is automatic and will only work while using the same device and browser to fill out all forms. If you’ve previously filled out a form, and the checklist is not reflecting your completed form accurately, please select the appropriate checkbox manually to update.