Please provide their name, address, phone number and email if available.
Please provide the attorney's name, address, phone number and email if available.
Please provide the ALL children's full name (as they appear in court order documentation), their dates of birth and the sex of each child.
Provide their name, phone number and email if available. Indicate "NA" if Not Applicable.
Indicate "NA" if no legal issues pending.
Indicate "NA" if Not Applicable
I understand I will receive acknowledgement of receipt of this screening form within 48 hours and I will then be scheduled for a required new-client orientation. I also understand Hannah's House will start working on contacting the other party to also get them started on the intake process, if they have not already done so. *
Orientation is a flat rate of $60 for a class orientation. Please come prepared by bringing copies of the following (if applicable to my case): Family Court Services (FCS) Report; Court Order; Restraining Orders; DV Filings; Proof of income (required if paying for services); Payment for orientation (NO personal checks); Valid ID. Should you need to cancel a scheduled orientation please inform Hannah's House. If you simply do not show up, you will incur a $60 no-show fee.