Parent Intake

You're taking a brave step. We're glad you're here.

This form takes about 5 minutes. It helps us understand where you are and how we can best support you as you prepare to reconnect with your child.

You don’t have to have all the answers. You just have to show up — and you’re already doing that. Fields marked * are required. A member of our team will reach out within 2 business days to talk through next steps together.

1 About you

Let's start with the basics so we know how to reach you.

First Name

Last Name

Phone Number

Email Address

Preferred Language

Best Time to Reach You

How would you like us to contact you first?

2 About your child

You don't need to share anything you're not comfortable sharing yet.

This is not a legal or clinical intake. We're not collecting information to share with anyone. We just want to understand your situation a little so we can match you with the right support from the start.

Child's First Name (or initials)

Child's Age

How long have you been separated from your child?

Are you currently in the court system related to this situation?

3 Where you are right now

No right or wrong answers here. Just honest ones.

What best describes your current situation? Check all that apply.

I have not seen my child in a while and want to reconnectI am preparing for court-ordered supervised visitsMy child is resistant or doesn't want to see meI have a court date coming up and need to show I'm taking stepsI want to understand how to approach the first visit the right wayI was referred here by my attorney or the courtI found TTS on my own and want supportOther

4 In your own words

This is your space. Say as much or as little as you like.

What is the most important thing you want us to know about your situation?

What do you most want for your child as a result of this work?

Is there anything you're nervous or unsure about in this process?

5 How did you find us?

This helps us reach more families who need support.

How did you hear about The Therapeutic Solution?

I understand that submitting this form does not create a therapeutic relationship with TTS. A member of our team will contact me within 2 business days to discuss next steps. I consent to being contacted at the phone number or email I provided above.

You've got this. Our team will reach out within 2 business days. If you have an urgent court deadline, please call us directly at (702) 485-1313 so we can prioritize your intake.

Before you submit. What you send is stored securely and seen by our staff. It is shared with a referral source, a court or another party only as your consent, a release, a court order or the law allows. Confidentiality has limits: some of our staff are required by law to report suspected child abuse or neglect, and information may have to be disclosed when a court orders it or to prevent serious harm. This form and our email are not monitored for emergencies. If you or a child are in danger, call 911; for emotional crisis support, call or text 988. See our Privacy Policy and Terms & Conditions. We cannot guarantee any court outcome.

Your information is sent over an encrypted connection.