Skip to main content
Skip to footer

Living Separately, Parenting Together: Solutions to Meet Your Family’s Unique Needs

Home
About
Services
Blog
Contact

Divorce in the 21st Century

Jordana Wolfson / May 4, 2022

Traveling When Divorced: How to Alleviate Stress on All Sides

One of the strangest things for people who just got divorced is not only are you living apart from your child, but all of a sudden, your children are going out …

Jordana Wolfson / March 30, 2022

Why I Blog

I’ve been blogging for so long now, that I sometimes forget to introduce myself and my purpose to new readers! So this month, I’d like to share why I started …

[Read more...] about Why I Blog

Jordana Wolfson / December 7, 2021

Parental Alienation, the Final Part

We’ve spent the past couple of months walking through a term that lots of divorced parents like to throw around: parental alienation. I’ve spent so much time on …

Contact

Co-Parenting Solutions
Jamestowne Executive Offices
31000 Telegraph Rd., Ste 280
Bingham Farms, MI 48025

248.330.5351
Email

About

Co-Parenting Solutions provides a multi-level approach to services that focuses on reducing parental conflict in order to enhance the child’s emotional functioning. Co-Parenting Solutions offers programs to address the relationship between separate households created as a result of separation or divorce.

Learn more | Book a Session

Follow Us on Facebook

Follow Us on Facebook

Home
About
▼
Services
▼
Blog
Contact

Collaborative Divorce with Mental Health Professional Agreement

Name*
First Last
Email*
Please indicate who is responsible for payment or if the fees are to be split by the parties:*
- Self
- Other
- Split
Other Responsible Party*
First Last
Phone
This field is for validation purposes and should be left unchanged.

Test Agreement

For testing only

Name
First Last
Email

Consent for In-Person Services During Covid-19 Public Health Crisis

Client Name*
First Last
Name of client or person acting as legal representative for the purposes of this agreement.
Client Email Address*

Email address of client or representative for purposes of this agreement.
Minor Name (if also applicable)
First Last
Client Relationship to Minor Child (if also applicable)
Email
This field is for validation purposes and should be left unchanged.

Client Intake Form

Step 1 of 3

33%

Client Name (Self)*
First Last
Name of Your Co-Parent
First Last
Mobile*
Work*
Email*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Place of Employment and Title*

How did you hear about Co-Parenting Solutions, LLC?*
Name of Therapist(s) Used for Self (if applicable)
Name(s) of Therapist(s) You Have Engaged the Services of for your Children (If Applicable)
Names of Any Legal Professionals You Have Engaged for Divorce Services
Which judge is assigned to your case?

List any professionals from Friend of the Court you are working with
Names and Ages of Shared Children
Please list shared children name(s) and age(s), one per line.
Names and Ages of Non-Shared Children
Please list non-shared children name(s) and age(s), one per line.
Comments
This field is for validation purposes and should be left unchanged.

Contract for Mediation Services

Name
First Last
Email
Name
This field is for validation purposes and should be left unchanged.

Contract for Court-Related Services

Client Name*
First Last
Email*
Name
This field is for validation purposes and should be left unchanged.

Contract for Co-Parenting Counseling and Skill Building Sessions

Client Name*
First Last
Email*
Email
This field is for validation purposes and should be left unchanged.

Consent for Therapeutic Treatment

Client Name*
First Last
Email*
Comments
This field is for validation purposes and should be left unchanged.

Consent for Minor Therapeutic Treatment

Client Name*
First Last
Client Email*
Minor Name:*
First Last
Additional Minor Names:
Please add the first and last names, one per line, for each additional minor covered by this agreement.
Client Relationship to Minor(s):*
Email
This field is for validation purposes and should be left unchanged.

Authorization to Release Confidential Information

Step 1 of 2 - Client / Signer Information

50%

Client Name*
First Last
Client Email*
Minor Name(s) and DOB (if also applicable)
One minor name and dob per line.
Maiden / Other Name
Client Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Source of Authority (if acting as legal representative of client)

This information will be released to Jordana Wolfson, LMSW, MA, ED SP, of Co-Parenting Solutions, LLC.
Person / Agency Releasing Information
List up to three entities that are authorized to release information.
Name(s) of Person/Agency*
Phone
Email
Person / Agency Releasing Information #2
Name(s) of Person/Agency
Phone
Email
Person / Agency Releasing Information #3
Name(s) of Person/Agency
Phone
Email
Information to be Released
This authorization is in effect for up to 5 years from date of signature unless you rescind same in writing to Jordana Wolfson, 31000 Telegraph Road, Suite 280, Bingham Farms, MI 48025.
Description of Information to be Released
- Co-Parenting Counseling
- Parenting Coordination
- Parent-Child Reunification Therapy
- Collaborative Divorce
- Parenting Time Agreement
- Divorce Mediation
- Other ...
Select all that apply.
if other, please describe
The Purpose and Need for Disclosure of Information
Comments
This field is for validation purposes and should be left unchanged.

Authorization for Teletherapy

Client Name*
First Last
Email*
Phone
This field is for validation purposes and should be left unchanged.

Credit Card on File Policy

Client Name*
First Last
Credit Card Type*
- Amex
- Visa
- Mastercard
Credit Card Number*
Expiration Date*
CVC Code*
Zip Code*
Cardholder Name*
First Last
Cardholder Email*
If your credit card is declined two consecutive times, we will be requesting a retainer before proceeding with new appointments.*
- By checking this box I agree to the terms mentioned above
Phone
This field is for validation purposes and should be left unchanged.

Notice of Privacy

Client Name*
First Last
Name of client or person acting as legal representative for the purposes of this agreement.
Client Email Address*

Email address of client or representative for purposes of this agreement.
Client Date of Birth*
MM slash DD slash YYYY
Minor Name (if also applicable)
First Last
Client Relationship to Minor (if also applicable):
Minor Date of Birth (if also applicable):
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Contact Us

Name*
First Last
Email*
Phone
How can we help?*
Comments
This field is for validation purposes and should be left unchanged.

Download our Co-Parenting FAQ

Name*
First Last
Email*

Divorce in the 21st Century

Footer

Contact

About

Follow Us on Facebook