San Diego High Conflict Diversion Program - Brook Olsen & Nicola Ranson

The San Diego High Conflict Diversion Program. Brook Olsen & Nicola Ranson

Brook Olsen, HHP/SEP - Nicola Ranson, LCSW/SEP

San Diego High Conflict Diversion Program
Parenting Class Registration Form

FAX 760-751-4398

Your Name:
Home Phone:
Work or Cell Phone:
Home Address:
City:
State:
Zip:
Email Address:
Other Parent’s Name:
Referred By:
Judge Assigned to Case:
Your Attorney’s Name:
Their Attorney’s Name:

Children’s Names and Ages: NAME AGE

How long have you been separated/divorced?

Briefly describe the issues that are part of the conflict between you and the other parent:

How many times have you been to Family Court Services or Family Court in the last 2 years?

Is there an attorney assigned to your children? YES NO If YES, who is it?

Is there a psychological evaluation ordered or completed? YES NO If YES, who did it or is doing it?

Are there counselors involved for you, your children or the other parent? YES NO If YES, who are they and who do they work with? NAME WHO THEY WORK WITH

Is this a divorce or paternity case? YES NO

What is your current child sharing arrangement or court order for child sharing?

Is there any thing else you would like us to know?

What would you like to take away from this program?

Informed Consent - The High Conflict Diversion Program is educational. It is not intended to be a substitute for family counseling, psychotherapy, or attorney advice. Personal matters may be discussed during these classes and I agree to keep such matters confidential. No portion of the text, written or verbal presentations may be reproduced without the written consent of the Director, Brook D. Olsen.
(Select button) Yes, I have read and agree to the terms and conditions above.
Signature (Type Name):
Date (Select):

FAX 760-751-4398

San Diego High Conflict Diversion Program Parenting Class Registration Form

San Diego High Conflict Diversion Program
Parenting Class Registration Form