Custody Intake Form

Name

Phone Number

Address

Employer Name, Address, Phone

Other parents's name

Children's address for 5 years **This is required**

Ages of children and birthdates

Date and location of marriage

Date of separation/divorce

Health of children

Describe the children's schedule as far as living situation and visitation the other parent or yourself for the previous 6 months

Describe any issues with drugs or moral character you may with the other parent

Is there an open dhs child support case?

Has there ever been a previously adjudicated order of custody?

Who will receive custody of the children and who will pay child support

What is your goal?