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Colorado

Serving El Paso County, Colorado

719-284-4115

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D&N Intake Form
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- Check Docket

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D&N Intake Form

Integrity Law > D&N Intake Form

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Single Line Text

Case #

Court Division

Respondent Parent

Your Name

DOB

Address

Email

Phone #

Do you have a pending criminal case?

Yes
No

If yes, what is the case # and attorney name?

Do you have a prior dependency case?

Yes
No

If yes, what is the case #?

Do You Have A Protection Order With Another Party?

Yes
No

Are You On Probation or Parole?

Yes
No

Please describe any disabilities you have.

If you have disabilities, do you have medical or other documentation?

Yes
No

Are any of your relatives or supports able to supervise (be with both you and your child) during your parenting time?

Yes
No

If yes, which person and for what time period?

Child 1 Name (Youngest)

DOB

Place of Birth

Does the child have Native American/Alaskan heritage?

Yes
No
Unknown

Name of child's father?

Father's name on birth certificate?

Where is the child's current placement?

Child 2 Name

DOB

Place of Birth

Does the child have Native American/Alaskan heritage?

Yes
No
Unknown

Name of child's father?

Father's name on birth certificate?

Where is the child's current placement?

Child 3 Name

DOB

Place of Birth

Does the child have Native American/Alaskan heritage?

Yes
No
Unknown

Name of child's father?

Father's name on birth certificate?

Where is the child's current placement?

Child 4 Name

DOB

Place of Birth

Does the child have Native American/Alaskan heritage?

Yes
No
Unknown

Name of child's father?

Father's name on birth certificate?

Where is the child's current placement?

If any of your children have out of state court custody orders, please list them.

Child Close Relative 1 Info: Name

Relationship

Address

Email

Phone

Child Close Relative 2 Info: Name

Relationship

Address

Email

Phone

Child Close Relative 3 Info: Name

Relationship

Address

Email

Phone

Child Close Relative 4 Info: Name

Relationship

Address

Email

Phone

Please provide a brief history of how this case started.

Integrity Law supports our clients and community members with passionate legal representation. Our legal team provides support to parents who are working to make a better life for themselves and their loved ones.

Jason M. Bell

Attorney At Law

6050 Stetson Hills Blvd Suite 202

Colorado Springs, CO 80923

admin@bellintegrity.com

Office: 719-284-4115

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