GENERAL INTAKE FORM - CoreTSolutions, llc.
Family and Juvenile Court Resource Services Referral
Email address *
CONTACT INFORMATION: Please provide all your contact information AND court case # / information. ALL CLIENTS MUST COMPLETE THIS SECTION: Name,Address, Phone Number & Email (must provide an email address), and Employer. *
Your answer
ATTORNEY Address/ph.#/email if represented.
Your answer
COURT CASE NAME AND CASE #: Please include the exact names and titles {i.e. Petitioner, Respondent} that are on the court documents AND CASE #.
Your answer
OTHER PARTY'S INFORMATION: Name, Address, Phone #, Email & Employer. Please include the name and contact information of other party's attorney if applicable. *
Your answer
Spanish Services - Necesita Ud. servicios en español?
Si necesita Ud. ayuda en español, llame al 559-400-5425 y un miembro del personal lo ayudará. Por favor deja un mensaje o mensaje de texto.
DO YOU NEED SPANISH SERVICES ?- Necesita Ud. servicios en español? *
PLEASE INDICATE ALL SERVICES YOU ARE ENROLLING IN: You must complete the form in all required and relevant services or areas. When you hit the "Submit" button at the end of this intake, all of this information will be sent directly to our office.
IF A REQUIRED RESPONSE SECTION DOES NOT APPLY TO YOUR CASE, PLEASE CHECK THE "NO" BOX OR TYPE "N/A". Otherwise, the submission will be invalid.
SERVICES: Please mark all that apply. *
Required
IS THERE A CURRENT COURT ORDER? If yes, please provide a full COPY of the Order or the most recent Minute Order if the Order After Hearing is not available yet. You can scan/email to our office: CoreTSolutionsEnroll@yahoo.com *
Required
If you answered "YES" above, please give a general summary of the Order: {Example: Father is custodial parent with Mother allowed supervised visits 2 hours per week}
Your answer
IS DOMESTIC VIOLENCE AN ISSUE IN YOUR CASE? (You do not have to have a current restraining order to answer yes to this question.) *
IS THERE A CURRENT RESTRAINING ORDER? If so, please provide a copy of the current R.O., or a copy of the Petition listing the reasons you're applying for an R.O.; please scan/email to CoreTSolutionsEnroll@yahoo.com ; you will NOT be enrolled in the same class. *
If you attempted to gain an Domestic Violence R.O. but it was not granted, please explain.
Your answer
*The Co-parenting courses and Parenting Courses meet the required (12) hour curriculum standards set by the Fresno Superior Court and other surrounding valley Courts.
The CO-PARENTING Classes are offered on average, every 4 weeks, usually on Tuesdays and Wednesdays, 5PM– 8 PM. PARENTING Classes will be scheduled every 2 months, normally on a 3 night/4 hour per night schedule. When you complete the intake, we will let you know when the next available class will start. Our website calendar will be updated as well. - At least one SPANISH CO-PARENTING CLASS will be offered every 2 months. The schedule will be maintained by the Bi-Lingual Instructor, Rebeca Castillo M.A., and she will update all clients immediately.

- The CO-PARENTING COURSE & PARENTING COURSE FEE is $325.00, but we offer a $25.00 discount for low-income families. We will also make payment arrangements with you, with minimum $85.00.00 payments. - The Certificate of Completion will be provided after completion of the Class AND upon payment in full.

FOR CO-PARENTING CLASS (OR) PARENTING CLASS CLIENTS: If you are attending Co-parenting or Parenting classes, please complete the following questions: *
Yes
No
Don't have an opinion
Does not apply to my case.
Have you attended Co-parenting or Parenting classes before?
I believe I need to learn skills to improve my co-parenting or parenting.
I believe the other parent needs to learn skills to better co-parent with me.
We both need to learn how to be better co-parents.
Do you believe you can learn new Co-parenting skills or new Parenting skills?
If domestic violence is an issue, do you believe you will gain skills to help you and your children better deal with the perpetrator?
FOR DRUG TESTING AND DRUG & ALCOHOL ASSESSMENT CLIENTS: Appointments must be made to go over testing and assessments. If you are seeking a Drug and/or Alcohol assessment or Drug Testing services, please check the correct box for the question: All testing is done through Reliance Drug Testing - 5612 N. Blackstone Fresno CA. We charge 25.00 administration fee and provide all results to parties and the Court. Payments for tests are paid directly to Reliance.
YES
NO
DRUG
ALCOHOL
BOTH DRUG & ALCOHOL
TEST RESULTS WERE POSITIVE
TEST RESULTS WERE NEGATIVE
Drug and/or Alcohol Assessments: Have you ever completed a drug/alcohol assessment before? Yes or No.
If yes, what type:
What were the overall results?
Do you have those assessment reports available for review?
Self-referred AND voluntary to CoreTSolutions
Court ordered to contact CoreTsolutions?
DRUG TESTING/ASSESSMENT DOES NOT APPLY TO MY CASE.
DRUG/ALCOHOL TESTING CLIENTS:
YES
NO
0 to 3 months ago
3-6 months ago
6-12 months ago
I have been asked to but I have never complied.
Scheduled testing
Random testing
Have you ever been tested before?
When did you last test?
If court ordered, do the terms require scheduled or random testing?
DRUG ASSESSMENT OR TESTING DOES NOT APPLY TO MY CASE
Who is ordered to pay for the registration and testing? *
Your answer
OTHER DETAILS the court has included in your drug testing terms:
Your answer
FOR SUPERVISED VISIT AND EXCHANGE CLIENTS: Supervised Visits or Exchanges require parties to attend an Orientation which is held every Monday at 4:00 PM. You must complete an Orientation before services can begin. If you are seeking supervised visitation or exchanges, please answer the following questions:
✽ Please note that all clients who seek Supervised Visits and Exchange services MUST: 1. Meet with a staff member and complete an Orientation interview, 2. complete all intake forms, 3. sign all contracts related to California Rule of Court rules and, 4. Sign all forms related to our company policies. We will NOT provide any services until any and all requirements are completed.
Are you the CUSTODIAL parent, or the VISITING parent who has supervised visits/exchanges? *
Your answer
How many hours per month/week is the visiting parent allowed to have supervised visits? (Please note that although a parent may be entitled to certain days/hours per the court order, the schedule is dependent on our agency's availability.) *
Which days would you prefer to have visits? (Please note that this is just to provide our office with your preference, but the actual final schedule will be based on both parents input and our availability.)
How many children will be part of the visitation program? *
What are the ages of the child/ren?
Main reason(s) Court has ordered supervised visits or exchanges? Check all that apply. *
Required
Is the supervised parent currently on PAROLE or PROBATION? If yes, please provide 1) a COPY of all Court/Agency reports detailing the terms of Parole or Probation, AND 2) the most current Parole/Probation officer report. Also, Please list all CPS history if any. In addition, please list all law enforcement contacts (i.e. summary of calls made, arrests, and the reasons for the calls/arrests, etc..)
If the visiting parent is on Parole or Probation, please mark the issues related to their case:
Custodial Parent's vehicle description & license plate # . Include as much information as possible. *
Your answer
Visiting Parent’s vehicle description & license plate #. Include as much information as possible. *
Your answer
ANY CONVICTIONS OF CHILD SEXUAL ABUSE WILL PRECLUDE A PARTY FROM PARTICIPATING IN SUPERVISED VISITS WITH OUR COMPANY.
ARE THERE CURRENT ACCUSATIONS OF CHILD SEXUAL ABUSE AGAINST THE VISITING PARENT? (Not convictions.) If yes, please provide copies of the law enforcement reports.
PRIVATE MEDIATION CLIENTS – You will be sent a separate Questionnaire when you enroll.
CLIENT TRANSPORT SERVICES: This service is sub-contracted out. Please include: 1) Name of Case, 2) Case Number, 3) Party to be transported, 4) Days & Times of transport, and 5) Locations of pick up and drop off:
Your answer
OFFICE SERVICES SURVEY: We have offices in Fresno and Madera currently. Which office do you prefer to have services at? Please mark any option that you prefer if you seek rural area services.
If seeking rural services, what is the primary service you need?
NOTE: Reminder that you must provide a current phone # AND email address for us to contact you.
Please include the phone # and email that you use or check on a regular basis.
CoreTSolutions, LLC has packages of information for each service that will be supplied to the client at their first scheduled appointment. Packages include: Fee Contracts, Policy and Procedures, Client Feedback/Surveys and Complaint Forms. The Co-parenting classes have full PowerPoint lectures that will be supplied to all clients for their keeping.
Thank you for contacting us. We look forward to serving your family. CoreTSolutions Staff
A copy of your responses will be emailed to the address you provided.
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