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Through the Vale Visitation & Family Services

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Intake Form

This intake questionnaire is designed to familiarize your provider with your case, needs, and concerns. Please be prepared to upload any relevant documentation, court orders, and formal photo identification. Please contact our office at info@throughthevale.com or (916) 360 - 0364 with any questions or concerns.

Service(s) Requested (mark all that apply)(Required)

Supervised Visitation

Supervised Exchange

Parenting Classes

Creation or Review of Parenting Plans

Other

How did you hear about us?

Personal Information

First name(Required)

Last name(Required)

Date of birth(Required)

Month

Day

Year

Email(Required)

Phone(Required)

Residential address

Country/Region(Required)

Address(Required)

Address - line 2

City(Required)

Zip / Postal code(Required)

I have a different mailing address

Party Information

Is there a no-contact order of any kind in place?

Yes

Unknown

Petitioner's full name(Required)

Petitioner's attorney(Required)

Attorney's Phone

Attorney's email(Required)

Petitioner's relationship to the children

Mother

Father

Other

Respondent's full name(Required)

Respondent's attorney(Required)

Attorney's Phone

Attorney's email(Required)

Respondent's relationship to the children

Mother

Father

Other

Minor Child(ren)'s Information

Number of children included in the order(Required)

Child's full name(Required)

Date of birth(Required)

Court Information

Case Number(Required)

Judge or Mediator(Required)

County(Required)

Date of last hearing(Required)

History

Estimate the number of times law enforcement has been called to enforce or assist with a no-contact order

Estimate the number of times law enforcement has been called to enforce or assist with a scheduled exchange or visitation

Is there a history of abuse towards the child(ren) by any other party in this order?

Yes

Unknown

Where did the last visitation or exchange take place?

Was the last visitation or exchange professionally supervised?

Yes

Unknown

When did the last visitation or exchange take place?

Additional information or concerns

Identification Information:

I do not have a vehicle

Vehicle Make & Model(Required)

Year(Required)

Lic. Plate Number(Required)

Primary Color(Required)

Personal identification(Required)

State-Issued Identification Card

State-Issued Driver's License

Permanent Residency Card

Passport

Identification number(Required)

Identification

Court Order

Additional Supporting Documents (if any)

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