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This form must be completed by either parent

prior to an intake appointment.

PLAINTIFF'S DETAILS

DEFENDANT'S DETAILS

DETAILS OF CHILD(REN)

Do you have a Court Order for services?
Yes
No

What services are you seeking?

IF YOU HAVE A SETTLEMENT AGREEMENT OR COURT ORDER FOR SERVICES, PLEASE EMAIL THEM TO BOTH:

LAUREN@BLAKEFAMILYCONSULTING.COM

SAMANTHA@BLAKEFAMILYCONSULTING.COM

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Mailing Address: 7 West Square Lake Road, Bloomfield Township, Michigan 48302

©2021 by Blake Family Consulting, LLC

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