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Name
*
First
Last
Phone Number
*
Email
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Zip Code
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Number of Children
*
1
2
3
4 or More
Do you have a copy of the court order?
*
No
Yes
Type of service requesting
*
Supervised Visits (in-person)
Safe Monitored Exchange Only
Private Room for Child's Testimonial
Virtual Visits (online)
Which party is responsible for covering the cost of services?
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Me
Other Parent/Guardian
50/50 Split Cost
Other
Other Parent's/Guardian's Information: Name, Phone, E-mail
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Upload Court Order
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Max file size: 20MB
Upload Additional Court Document(s)
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Max file size: 20MB
Please briefly describe why our services are needed.
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How did you hear about us?
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Judge
Attorney
Court List
Social Media
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Family/Friends
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Welcome
Visits & Exchanges
Resources
Contact