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

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Family Matters

Jordana Wolfson / March 30, 2021

Don’t Disparage The Ex

It’s become common knowledge that divorced parents should not speak negatively about the other parent to their children. But it seems that extended family …

Jordana Wolfson / April 1, 2019

Child Protective Services Is NOT a Personal Divorce Weapon!

It is incredibly sad when a child is being abused physically, sexually and/or emotionally. When parents are consistently engaged in conflict with one another …

Jordana Wolfson / December 24, 2017

Holidays and the (Extended) Family

One of the challenges for children of parents who do not live together is developing and maintaining ties with extended family members… aunts, uncles, …

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

248.330.5351
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Co-Parenting Solutions provides services that focus on reducing parental conflict to enhance children’s emotional functioning. Co-Parenting Solutions helps co-parents address the relationship between separate households created as a result of separation or divorce.

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Collaborative Divorce with Mental Health Professional Agreement

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Test Agreement

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

Client Name*
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Name of client or person acting as legal representative for the purposes of this agreement.
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Minor Name (if also applicable)
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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.
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Contract for Mediation Services

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Contract for Court-Related Services

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Contract for Co-Parenting Counseling and Skill Building Sessions

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Consent for Therapeutic Treatment

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Consent for Minor Therapeutic Treatment

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Minor Name:*
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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):*
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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
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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.
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Person / Agency Releasing Information #2
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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
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- Divorce Mediation
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Authorization for Teletherapy

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Credit Card on File Policy

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If your credit card is declined two consecutive times, we will be requesting a retainer before proceeding with new appointments.*
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Notice of Privacy

Client Name*
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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*
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Minor Name (if also applicable)
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Client Relationship to Minor (if also applicable):
Minor Date of Birth (if also applicable):
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