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New Client Enrollment

Click Here to

Complete Intake Form for

Regular

Supervised Parenting Time

Click Here to

Complete Intake Form for

Therapeutic

Supervised Parenting Time

Intake Form for Supervised Parenting Time

First name*

Last name*

Email*

Phone*

Street Address, City, State, Zip*

I am the...*

County Case is Managed*

Case Number & Judge

Type of Parenting Time Ordered*

Other Parent's Name and Contact Information

Names and Birthdates of Children Involved in Vistiation

Your Attorney's Contact: Name, Phone Number & Email Address*

What does the Order say regarding parenting time? (If you don't have the order- what do you recall was said in court?)

Please Upload the Court Order Here:

Concerns:

Substance Abuse

Domestic Violence

Mental Health

Open CPS Case

Long Term Separation

No Contact Order or PPO

Other

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Location

Email

1645 Fort Street Wyandotte, MI 48192

(734) 720-9234

Phone

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