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Intake/Referral Form for Private and Family Law Court Requests

This form represents the first step in the intake process with Family Konnect. All negotiations, including those involving legal representatives, must be finalised prior to commencing this process. Completion of this form by both parties is required before Family Konnect can provide services. The form takes approximately 10–12 minutes to complete

(Court ordered supervised contact, introduction to child, history of mental health, substance misuse)

Independent child/ren's Lawyer (ICL)

If not applicable type N/A

If not applicable type N/A

If not applicable type N/A

Your details

If not applicable type N/A

If not applicable type N/A

Interpreter Required?
Yes
No

Other parent's details

Child's details

Names of Child/ren, Gender, D.O.B and any care needs such as Food allergies, Medical information or Behavioural issues

Type of service required:

Select from the following

Note: Minimum Service Hours Is 3 hrs

Orders:

Confidentiality

Can your contact details be known or given to the other party?
Yes
No

Supervised transport

Will the child/ren require transport by Family Konnect?
Yes
No
If yes, please specify the type of car seats are required

Parents meeting arrangement

Will both parents be present at handover of the child/ren prior to the service start time?
Yes
No

Parents meeting arrangement

Intake assessment and its purpose:

The purpose of the Intake Assessment is:


  • To identify the child/ren's needs and how we can best support them.

  • To consider the nature and extent of any risk.

  • To appraise whether the service has the capacity and resources to provide the required supervision.

  • To have a full and frank exchange of information between each party and this agency so that each can make an informed decision. The information exchange will include details of the service's purpose, duration, limitations, and costs of the services.

  • Assess whether the proposed arrangements serve the interests of the child.


Any changes/ additional dates must be approved by both parties and sent in writing to Family Konnect.


Parental signature

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Signature

Next Steps

  • We’ll contact you within one business day to book a short phone intake assessment.

  • On that call, we’ll ask a few brief questions about your child, your situation, and the days/times you’d like services to occur.

  • After the call, you’ll receive a Service Agreement for signature outlining roles and responsibilities for all parties (including the Family Konnect supervisor), payment terms, our cancellation policy, and reasons services may be terminated.

  • Once signed, we’ll send a proposed schedule for visits/changeovers based on your availability.

  • After you confirm the schedule, we’ll allocate a supervisor and arrange the visits, keeping you updated at each step.

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If anything changes on your side, let us know; we’ll adjust quickly to keep things predictable for your child.

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