Visiting Parent Confidential Intake Form

Important Note: This form will need to be filled out in one sitting as it does not save for you to come back to. Please wait for the confirmation message before exiting the page. Please also see important notes at the bottom of the page.

Client Information:

First Name

Last Name

Address:

Cell Phone:

Work Phone:

Date of Birth:

Driver's License Number:

Vehicle Information:

Other Parent's Information:

Other Parent's Name:

Other Parent's Cell Phone:

Attorney's Information:

Attorney's Name:

Other Parent's Attorney:

Child/Children's Information:

Child's Information:

Please list any special needs of the child(ren), including any allergies:

Please list the name(s) and phone number(s) of any person(s) authorized to pick up and/or drop off the child(ren):

Signature:

Date:

Upload Court Order:

Upload File

Any additional information you believe is important for Forward Steps to know:

Your information has been received.

Important Information

Policies and Procedures Form: Our Policies and Procedures form must also be completed to register with our agency. Please complete the form here.

Fee Schedule: Our Fee Schedule can be found here.

Online Payment: Payment for services can be made here.

Manual Form Submission: If you're unable to complete the forms online, you can download them via the links below, fill them out and email them to office@forwardstepsfamilyservices.com

Policies and Procedure Form

Visiting Parent Confidential Intake Form