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          Trained in   Collaborative Divorce sm  model                

 

 

SOMEDAY, MAYBE 

THERE WILL EXIST A WELL-INFORMED,  WELL-CONSIDERED, AND YET FERVENT PUBLIC CONVICTION THAT THE MOST DEADLY OF ALL POSSIBLE SINS IS THE  MUTILATION OF A CHILDíS SPIRIT.

  ERIK ERIKSON

DOCUMENT CREATION FORM Information Survey  

THE INFORMATION YOU PROVIDE IS CONFIDENTIAL .

the purpose of this is to assist mediation especially in situations where parents live in different cities or states. however, we are finding it also valuable in local mediations also. Fill out the information in each section as requested. skip any section that does not apply.  this survey is optional   at the end of the form supply your EMAIL ADDRESS, and submit the form. You will receive a confirmation message from us shortly. 

mother name 

father name

   

EXPLAIN if needed    

 

 STATUS QUO

The following represents the status quo with respect to the child: 

Children's school/daycare provider is

The Child(ren) are being raised with exposure to and the opportunity to participate in  

religion

our child(ren)ís primary doctor is

our child(ren)ís dentist is

 domestic vioilence informationclick here for more
 domestic violence information

SCHOOL SCHEDULE

click hereSCHOOL SCHEDULES FOR More infORMATION 

 

SCHOOL SCHEDULE          
 shall have the following time with the children
 
    FREQUENCY
BEGINning
DAY                           time                  LOCATION 
        ENDS
  DAY                           time                  LOCATION 

   

DESCRIBE if needed  and added information
  

 
SUMMER SCHEDULE 
click here   SUMMER SCHEDULES   for more INFORMATION
 
 
the summer schedule shall be as follows
Each parent will have 
VACATION PERIODS PER YEAR FOR UP TO 
EACH YEAR                
WEEK NOTICE REQUIRED OF WHEN  
PARENT WILL GO ON VACATION
 
IF THE SUMMER SCHEDULE IS TO CHANGE  
WILL HAVE THE CHILDREN
    FREQUENCY
BEGINning
 
DAY                           time                  LOCATION 
ENDS
 DAY                           time                  LOCATION 
 
DESCRIBE if needed 
and added information
 
    

 

HOLIDAYS

AFTER THE ABOVE IS SENT TO US

 WE WILL SEND YOU A FORM THAT WILL COVER THE FOLLOWING TOPICS.  

 

WE HAVE FOUND THAT IF 

LEGAL CUSTODY, SCHOOL AND SUMMER CANNOT BE AGREED ON, USUALLY IT WILL BE A WASTE OF TIME TO DISCUSS THE FOLLOWING.     

CHRISTMAS / HANUKAH

click here HOLIDAY  SCHEDULEdec 25th more info 

 

DESCRIBE if needed 

 

THANKSGIVING nov 25th     

click here HOLIDAY  SCHEDULE more info 

 

DESCRIBE if needed 

 

EASTER april sunday                                         

click here HOLIDAY  SCHEDULE more info 

DESCRIBE if needed 

   

BABYSITTING EXPLAIN IF NEEDED    

 

   

TELEPHONE EXPLAIN IF NEEDED   

 

 

TRANSPORTATIONEXPLAIN IF NEEDED  

 

 

OTHER CONCERNS EXPLAIN IF NEEDED  

 

Email     ***REQUIRED FIELD***  

     FORM SUBMISSION

Thank you for taking the time to answer the questions . Now we can better assist any question that you may have and may be able to assist in development any documents or additional information needed.

David Stewart LPMHC
Copyright © 1999 [www.meduateus.com]. All rights reserved.Revised: .

 

Phone Sessions
mailto:webmaster@mediateus.com                  Taos Office         575-737-9348 
                  Santa Fe Office 866-737-9348 TOLL FREE     
                       Fax               575-737-5844  

                    

Physical address  

  please feel free to visit our Taos office any time, Drop ins welcomed

          705 Felicidad Taos, NM    Taos Maps and Driving Directions           
                       

Postal address                

                        705 felicidad 8021 NDCBU Taos, NM 87571

 
Last modified: September 10, 2009 
Copyright © 2001 MediateUS
Email  webmaster@mediateus.com 
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