FREE CONSULTATION FORM

By submitting this form, you understand and agree that the information you provide will only be used for the purpose of a Free Consultation. The information you are submitting is necessary for us to better understand the complexity of your parent-child relational problems.

YOUR INFORMATION WILL REMAIN CONFIDENTIAL

Although this document contains many questions, and requires the time to fill it out we can only offer you a free consultation if you send us the history of your case and your particular circumstances in advance.

After your information has been reviewed a consultant will contact you to arrange a telephone consultation appointment. Please allow 24 - 48 hours to review your form.

CONSULTATION INFORMATION

First NameLast Name

Area CodeTelephone Number

Email Address

City You Live InStateProvince

Jurisdiction/ Legal Jurisdiction of Your Case

If you do not have a case filed with the court please check this box

I am presently separatedI am presently divorcedNever Married

Number of Children involved in this matter

Sex and Age of Child(ren) involved in this matter :
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I am currently represented by a lawyerYesNo

I am currently working with my2nd lawyer on this case

I am currently working with my3rd lawyer on this case

I am currently not represented by a lawyer

I am currently representing myself as my own lawyer

 

I am satisfied with the current representation from my lawyer

I am not satisfied with the current representation of my lawyer

I am not sure if I am satisfied with the current representation of my lawyer

QUESTIONS ABOUT PHYSICAL CUSTODY

A court order states that I currently have the following terms of physical custody :

Joint physical custody of my child - FMAge

Joint physical custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order states that I currently have sole physical custody of my child - FMAge

A court order states that I currently have sole physical custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order states that I currently have no physical custody of my child - FMAge

A court order states that I currently have no physical custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT LEGAL CUSTODY

A court order states that I currently have the following terms of legal custody :

Joint legal custody of my child - FMAge

Joint legal custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order states that I currently have sole legal custody of my child - FMAge

A court order states that I currently have sole legal custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order states that I currently have no legal custody of my child - FMAge

A court order states that I currently have no legal custody of my children ( the following Sex and Ages below )
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT MY LOSS OF PARENTAL RIGHTS

A court order states that I currently have no legal rights with my child - FMAge

A court order states that I currently have no legal rights with my children who are the following sex and ages below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT ACCESS AND VISITATION

My Child, FMAge continues to visit with me in compliance with the court ordered schedule.

My Children listed below continue to visit with me in compliance with the court ordered schedule
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My Child, FMAge no longer continues to visit with me in compliance with the court ordered schedule.

My Children listed below no longer continue to visit with me in compliance with the court ordered scheduled
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order currently states that I have overnight visitations with my child
FMAge

A court order currently states that I have overnight visitations with my children
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order currently states that I have no overnight visitations with my child
FMAge

A court order currently states that I have no overnight visitations with my children
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order currently states that I have daytime or evening visitations but no overnight visitations with my child - FMAge

A court order currently states that I have daytime or evening visitations but no overnight visitations with my children
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A court order currently states that visitations are at the discretion of my child - FMAge

A court order currently states that visitations are at the discretion of my children
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is no court order for access or visitation with my child - FMAge

There is no court order for access or visitation with my children listed below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I am not having any access or visitation with my child FMAgeand there is no court order for access and visitation.

I am not having access or visitation with my children listed below and there is no court order for access and visitation.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

Check this boxif there is only a Settlement Agreement between you and your former spouse / partner that specifiy's the access and visitation schedule

QUESTIONS ABOUT COUNSELING

There is currently a court order appointing a therapist to provide Individual Counseling to my child - FMAge

There is currently a court order appointing a therapist to provide Individual Counseling to my children
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a therapist providing Individual Counseling to my child, but this therapist is not court appointed. My child - FMAge

There is a therapist providing Individual Counseling to my children, but this therapist is not court appointed. The following children listed below are meeting with this therapist:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

Check this box if there is a court order that states you have joint legal custody of your child, and the child is seeing the therapist without your informed consent.

If there is a court order that states you have joint legal custody of your children and if one or more of the children are seeing a therapist without your informed consent, list the sex and ages of the children who are meeting with this therapist:

FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a court order that provides for Conjoint Counseling between me and my child, FMAge, and this court order does not require the other parent to participate in the counseling.

There is a court order that provides for Conjoint Counseling between me and my children listed below and this court order does not require the other parent to participate in the counseling.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a court order that requires both parents and my child, FMAge to participate in Family Counseling.

There is a court order that requires both parents and the children to participate in Family Counseling. The sex and ages of the children participating in counseling are listed below.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a court order that requires both parents and my child, FMAge to participate in Reunification Counseling.

There is a court order that requires both parents and the children to participate in Reunification Counseling. The sex and ages of the children participating in Reunification Counseling are listed below.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a court order for Reunification Counseling but the court order only requires me and my child, FMAge to particpate in the counseling.

There is a court order for Reunification Counseling but the court order only requires me and the children listed below to participate in the counseling.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT COURT APPOINTED PROFESSIONALS

A court order has appointed one or more of the following professionals in my case: A Guardian Ad Litem for my child, FMAge

A Guardian Ad Litem for the following children below:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A Lawyer for my Child - FMAge

A Lawyer for the following children below:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A Parenting Coordinator for the child - FMAge

A Parenting Coordinator for the following children below:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

A Family Mediator

A Special Master

Other - Please Specify

There are ongoing issues being referred to a Friend Of The Court
Specify those issues

QUESTIONS ABOUT YOUR CUSTODY EVALUATION

There is a court appointed Custody Evaluator presently involved in my case
At this time there is no court appointed Custody Evaluator involved in my case .
There was a Custody Evaluator previously appointed in my case
Specify the month and year of the report completed by the Custody Evaluator .
I have been advised by my lawyer to seek an order for a Custody Evaluation .

QUESTIONS ABOUT RESTRAINING ORDERS

There is currently a restraining order in place with the court
Specify the details of this restraining order and who it applies to below:

There are no restraining orders in place with the court at this time
There was a restraining order previously issued by the court in my case
but the restraining order has been vacated
There is a mutual restraining order involved in my case at this time

QUESTIONS ABOUT FAMILY PROFILE

There is a history of domestic violence involving me and my former spouse/partner

There is no history of domestic violence involving me and my former spouse/partner

My children listed below were exposed to acts of domestic violence that took place between myself and my former spouse/partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has been exposed to acts of verbal abuse

My children have never been exposed to acts of verbal abuse .

My children listed below have been exposed to acts of verbal abuse
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge was exposed to verbal abuse from me.

My child FMAge was exposed to verbal abuse from my former spouse/partner.

My children listed below were exposed to verbal abuse from me
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My children listed below were exposed to verbal abuse from my former spouse/partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I have no history of alcohol or substance abuse
I do have some history of alcohol abuse documented in my case
I do have some history of drug abuse documented in my case

There is no history of alcohol or substance abuse involving my former spouse/partner

There is some history of alcohol abuse documented in my case relating to the conduct of my former spouse/partner

There is some history of drug abuse documented in my case relating to the conduct of my former spouse/partner

My child FMAge has been exposed to my substance abuse.

The following children listed below have been exposed to my substance abuse:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has been exposed to my former spouse/partner's substance abuse.

The following children listed below have been exposed to my former spouse/partner's substance abuse
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has received corporal punishment on occasions from me.

The following children listed below have on occasion received corporal punishment from me
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has on occasion received corporal punishment from my former spouse/partner.

The following children listed below have on occasion received corporal punishment from my former spouse/partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There are currently no Child Protection Service investigations involved in my case relating to my conduct
There are currently no Child Protection Service investigations involved in my case relating to the conduct of my former spouse/partner
There are currently allegations being made by my former spouse/partner regarding child abuse against my child FMAge

There are currently allegations being made by my former spouse/partner regarding child abuse against the following children listed below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

There is a Child Protection Service investigation taking place right now involving my conduct or involving my former spouse/partner's conduct
There is a history of Child Protection Service investigations involving my child FMAge

There is a history of Child Protection Service investigations involving the following children listed below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

Prior Child Protection Service investigations involving my conduct ended up being reported as "Unfounded "
Prior Child Protection Service investigations involving my conduct with my child FMAge did end up being reported as "Confirmed ".

Prior Child Protection Service investigations involving my conduct with the following children listed below did end up being reported as "Confirmed "
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

Prior Child Protection Service investigations involving the conduct of my former spouse/partner's conduct with my child FMAge did end up being reported as "Confirmed".

Prior Child Protection Service investigations involving the conduct of my former spouse/partner's conduct with the following children listed below did end up being reported as "Confirmed "
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT PROFILES IN PARENTING

My former spouse/partner describes my parenting style with my child FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

FMAge as being :
Rigid or overly rigid
Passive or uninvolved
Reactive or highly reactive
Harsh or overly critical
Controlling
Insensitive
None of the above

QUESTIONS ABOUT PARENT-CHILD RELATIONSHIPS

My child FMAge is currently closely bonded to me and we have a normalized relationship.

My children listed below are closely bonded to me and we have a normalized relationship
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge expresses difficulty coming with me during the physical custody exchange.

My children listed below express difficulty coming with me during a physical custody exchange
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge is very rejecting of me and says negative things about me all the time.

My children listed below are very rejecting of me and say negative things about me all the time:
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge not only rejects me, he/she also rejects my extended family.

My children listed below, not only reject me, they also reject my extended family.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has become physically abuse towards me.

My children listed below, have become physically abusive towards me.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has a history of self-injuring behavior.

My children listed below have a history of self-injuring behaviour
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge is taking psychotropic medication.

My children listed below are taking psychotropic medication.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I disagree with the need for my child, FMAge to be on psychotropic medication.

I disagree with the need for my children listed below to be on psychotropic medication
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge continues to have regular visitation with me but constantly pleads to reduce our time together.

My children listed below continue to have regular visitation with me but constantly plead to reduce our time together.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge is complaining that he or she is afraid of me or anxious when he or she visits with me.

My children listed below are complaining that they are afraid of me or anxious when he or she visits with me
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has a major complaint about being around my new spouse or partner.

My children listed below have a major complaint about being around my new spouse or partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My last visitation with my child, FMAge was on or approximately .

My last visitation with my children listed below was:
FMAge - Last visitation was on
FMAge - Last visitation was on
FMAge - Last visitation was on
FMAge - Last visitation was on
FMAge - Last visitation was on
FMAge - Last visitation was on

My child FMAge has no complaints about my new spouse or parent.

My children listed below have no complaints about my new spouse or partner.
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

QUESTIONS ABOUT PERSONAL COUNSELING

I am on a voluntary basis seeing a mental health professional for counseling
I know that my former spouse/partner is on a voluntary basis seeing a mental health professional for counseling
I have been court ordered to seek some form of individual counseling
My former spouse/partner has been court ordered to seek some form of individual counseling

QUESTIONS ABOUT THE BEHAVIOUR OF THE CHILDREN

My child / children presently exhibit the following behaviours

On occasion or often calls me by my first name

Is influenced by a sibling that rejects any relationship with me

Keeps secrets from me but shares these secrets with my former spouse/partner

Keeps secrets from me but shares these secrets with his or her siblings

Sometimes or frequently comes to visit without important personal items ( i.e. clothing, books, laptop, etc. )

Uses a different last name or a nickname or a different version of his or her first name at the home of my former spouse/partner

Voices concerns about his or her safety when with me

Voices his or her critical opinion about their other parent

Is empathetic of my feelings

Has clear memories of happy times in our relationship

Is often times affectionate with me

Communicates with me by text and or by Skype

My child FMAge wants to please both parents.

My children listed below want to please both parents
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge is closely bonded with my new spouse/partner .

My children listed below are closely bonded to my new spouse/partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child FMAge has lost all interest in a family pet.

My children listed below have lost all interest in a family pet
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My children listed below sometimes complain about
FMAge Panic attacks feeling anxious suicidal ideation
FMAge Panic attacks feeling anxious suicidal ideation
FMAge Panic attacks feeling anxious suicidal ideation
FMAge Panic attacks feeling anxious suicidal ideation
FMAge Panic attacks feeling anxious suicidal ideation
FMAge Panic attacks feeling anxious suicidal ideation

My children listed below exhibit the following features:
FMAge Excessive weight gain cutting False Memories
FMAge Excessive weight gain cutting False Memories
FMAge Excessive weight gain cutting False Memories
FMAge Excessive weight gain cutting False Memories
FMAge Excessive weight gain cutting False Memories
FMAge Excessive weight gain cutting False Memories

When we are together, my child, FMAge has infrequent communications with my former spouse/partner.

When we are together, my children listed below have excessive communications with my former spouse/partner
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

My child, FMAge rarely has after school activities that interfere with our time together.

My children listed below frequently have after school activities that interfere with our time together
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I often learn about my child's, FMAge medical appointments after they take place.

In reference to the children listed below, I often times learn about their medical appointments long after or shortly after they take place
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

MISCELLANEOUS QUESTIONS

I learned about this website through my own research

I was referred to this website by a lawyer a mental health professional a family member or significant other another organization a friend

I am being falsely accused of alienating my child, FMAge

I am being falsely accused of alienating my children listed below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I have lost some of my parental rights because the court has found me responsible for alienating my child, FMAge

I have lost some of my parental rights because the court has found me responsible for alienating my children listed below
FMAge
FMAge
FMAge
FMAge
FMAge
FMAge

I have very little understanding of parental alienation

I have a fairly advanced understanding of parental alienation

I believe that my lawyer has very little understanding of parental alienation

I believe that my lawyer has an advanced understanding of parental alienation

I believe the following professionals coming into contact with me and my child/children have very little understanding of parental alienation:

Guardian Ad litem lawyer for the child/children Parenting Coordinator Mediator Custody Evaluator Therapist for the child/children family therapist Reunification therapist

I believe the following professionals coming into contact with me and my child/children have a good understanding of parental alienation:

Guardian Ad litem lawyer for the child/children Parenting Coordinator Mediator Custody Evaluator Therapist for the child/children family therapist Reunification therapist

Concerns about parental alienation have already been expressed to the court by me my lawyer the guardian ad litem the lawyer for the child/children custody evaluator the mediator therapist for the child/children family therapist Reunification therapist others