Intake Form

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

YYYY

Emergency Contact

Please include both the name AND telephone number for your emergency contact.

Spouse/Partner Name

This should be the spouse/partner at issue whether that is the one you are divorcing, or the one you have divorced that there are current issues with.

Children(s) Names & Ages

Please include the full name and age for all children that are yours and your partner's. Step-children or children from a different partner are not required at this stage.

How did you hear about me?

Referral from a friend

Referral from a legal professional

Referral from One Mom's Battle

Web/Google search

Other

Pre/During/Post-Divorce

What type of services are you seeking?

Pre-Divorce (thinking of filing)

During Divorce (having issues currently)

Post-Divorce (Enforcement)

Post-Divorce (Modification)

Who initiated the ending of the relationship?

If the relationship is ending now, please indicate whether you initiated the ending or your spouse did. If you are post-divorce, please select "Post-Divorce".

Ending now (Me) - I initiated the ending of the relationship.

Ending now (Partner) - My partner initiated the ending of the relationshpi

Post-Divorce

Length of Marriage

You do not need to be exact. A general length in years is fine.

Cohabitation Status

Living Together

Separated

Post-Divorce

Safety Concerns

Are you in fear for your safety or the safety and well-being of your children or others in your household?

Yes

Safety Concerns (optional)

If you answered "yes" to the previous question, please give me a general description of the nature of your safety concerns.

Abuse status?

Have you or your child(ren) suffered any of the following forms of abuse (check all that apply)?

Physical Abuse

Emotional Abuse

Financial Abuse

Post-Separation / Post-Divorce

False Parental Alienation Claims

Income Generation

Who is/was the primary income generator in the relationship?

My Spouse/Ex-Spouse

We both contributed

Attorney Status

If you have an attorney already, please state his or her name. if you do not, please say "none".

Attorney Status (supplemental)

If your current attorney is not your first attorney, please state the name of all attorneys who have previously represented you before your current attorney. If none, please skip this question.

Mediation Status

If your case is on file (divorce or post-divorce), have you mediated?

Divorce on file - no mediation

Divorce on file - mediated temporary orders

Divorce on file - mediated final, but did not settle

Post-Divorce - mediated post-divorce temporary orders

Post-Divorce - mediated final and did not settle

Not on file / Not applicable

Mediation Supplemental Information

If you selected any box in the previous question other than "Not on file/Not Applicable", please complete this question and try to be as detailed as possible with mediator name(s), dates, what was being mediated, etc.

Spouse/Ex-Spouse Attorney

If your spouse/ex-spouse is currently represented, please state the lawyer's name. If not, please state "none."

Spouse/Ex-Spouse Previous Attorneys

If your spouse/ex-spouse's current attorney is not his/her first attorney, please state the name of all attorneys who have previously represented her/him before his/her current attorney. If none, please skip this question.

Court Number

if your case is already on file, please state the Court number where it is pending. If not, please put "none."

Judge's Name

If you know the name of your judge, please indicate here. If not, please skip this question.

Amicus Status

If your case is/was on file, was there an Amicus Attorney appointed?

Yes, we have/had an Amicus

No, we did not have/had an Amicus

My case has not been filed yet

Name of Amicus

If you have/had an Amicus, please tell us his/her name.

Terms & Conditions

Before submitting, you MUST agree that submitting this form does not create any form of agreement or relationship between you and Red Thread Divorce Consulting. Further, By signing this document, I acknowledge that Red Thread Divorce Consulting, LLC is not qualified to offer mental health advice nor is she able to provide legal advice. Red Thread Divorce Consulting LLC is able to offer support during high conflict divorces or custody battle but by no means is designed to replace the services of a therapist or an attorney. Please remember that communication and honesty is of the utmost importance during coaching sessions and these pieces serve as the foundation of our relationship.

I AGREE to the Terms & Conditions

Red Thread Divorce Consulting