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Intake Form for Third Party Screening for Family Arbitration

Please sign the Consent to Third Party Screening and include it with this intake form.

This document is strictly confidential. It is being completed by you and provided to us as part of a confidential meeting for the purpose of Third Party Screening for Family Arbitration and will be read only by our staff, for administrative purposes, and by the Third Party Screener who will be meeting with you.  We will not share the information in this form, or any information arising from this Third Party Screening Process, with anyone other than your arbitrator, who is required to keep it confidential. The only exceptions to confidentiality are if we receive information you suggesting that a child may be in need of protection, if we believe based on information provided that a person is in imminent danger or if a judge orders disclosure of information.

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A PDF version of the Intake Form is available.

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Intake Form for Third Party Screening for Family Arbitration

  • Child's NameAgeChild is Living With 
  • Child's NameAgeChild is Living With 
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