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Co-Parenting Solutions, LLC

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

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    • Parenting Time Coordination
    • Parent-Child Reunification
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Client Forms

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*
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).


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.


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.

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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.

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Copyright © 2021 Co-Parenting Solutions, LLC

Collaborative Divorce with Mental Health Professional Agreement
  • This field is for validation purposes and should be left unchanged.

Test Agreement

For testing only
Consent for In-Person Services During Covid-19 Public Health Crisis
  • Name of client or person acting as legal representative for the purposes of this agreement.
  • Email address of client or representative for purposes of this agreement.
  • This field is for validation purposes and should be left unchanged.
Client Intake Form

Step 1 of 3

33%
  • Please list shared children name(s) and age(s), one per line.
  • Please list non-shared children name(s) and age(s), one per line.
  • This field is for validation purposes and should be left unchanged.
Contract for Mediation Services
  • This field is for validation purposes and should be left unchanged.
Contract for Court-Related Services
  • This field is for validation purposes and should be left unchanged.
Contract for Co-Parenting Counseling and Skill Building Sessions
  • This field is for validation purposes and should be left unchanged.
Consent for Therapeutic Treatment
  • This field is for validation purposes and should be left unchanged.
Consent for Minor Therapeutic Treatment
  • Please add the first and last names, one per line, for each additional minor covered by this agreement.
  • This field is for validation purposes and should be left unchanged.
Authorization to Release Confidential Information

Step 1 of 2 - Client / Signer Information

50%
  • One minor name and dob per line.
  • 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.
  • Person / Agency Releasing Information #2

  • Person / Agency Releasing Information #3

  • 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.

    Select all that apply.
  • This field is for validation purposes and should be left unchanged.
Authorization for Teletherapy
  • This field is for validation purposes and should be left unchanged.
Credit Card on File Policy
  • This field is for validation purposes and should be left unchanged.
Notice of Privacy
  • Name of client or person acting as legal representative for the purposes of this agreement.
  • Email address of client or representative for purposes of this agreement.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Contact Us

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Download our Co-Parenting FAQ

  • Home
  • About
    ▼
    • Jordana Wolfson
    • Resources
    • Testimonials
    • Client Forms
  • Services
    ▼
    • Co-Parenting Counseling
    • Collaborative Divorce
    • Mediation
    • Parenting Time Agreements
    • Parenting Time Coordination
    • Parent-Child Reunification
    • Blended Families
  • Blog
  • Contact