Defenders of Children
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Intake Form

Name(Required)
MM slash DD slash YYYY
Race/Ethnicity

Legal Intake Form

PLEASE NOTE: All information provided to Defenders of Children through this initial intake form will be kept strictly confidential by Defenders of Children. However, simply completing and submitting this initial intake form will not establish an attorney-client relationship between you and Defenders of Children. By completing and submitting this initial intake form, you are applying for legal assistance from Defenders of Children, not retaining Defenders of Children to assist you.
In what legal area(s) do you want assistance?
Address
Please list the child(ren)'s name and dates of birth.

Opposing Party's Information

MM slash DD slash YYYY
OP's address

Department of Child Safety (DCS) and Law Enforcement Information

Maricopa County only

Behavioral Health Information

PLEASE NOTE: All information provided to Defenders of Children through this initial intake form will be kept strictly confidential by Defenders of Children.
Please check all that apply
If yes, full custody documents and/or divorce degree will be needed along with OOP, if one is in place, to ensure there is a clear understanding of the parent's ability to consent to clinical services
Please list the names and ages of child(ren) if services are being requested for them.
Please briefly explain why you are requesting mental health services for yourself and/or your child(ren).

Defenders of Children

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  • Meet The Team
  • Community Partners
  • Supporters
  • Testimonials

Services

  • Clinical Services
  • Family Law Services
  • Other Civil Legal Services
  • Educational Advocacy
  • Supervised Parenting Time

Support

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  • Contact
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Links

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  • Victims’ Rights
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