Our Experience Can Change Your Life

Intake Forms

All of our forms are linked below! Each form takes less than 5 minutes to complete and sign. 

After you submit the intake, our intake coordinator will reach out to you to discuss the next steps. 

A sliding scale fee form must be completed for each client. 

Coparenting Intake

Sliding Scale Fee Form

(Must be completed for each client)

Coparenting Intake

Sliding Scale Fee Form

(Must be completed for each client)

About the Forms

Unsure of what intake forms to complete?

Child Intake Form needs to be completed by each parent unless one parent has sole legal custody then that parent is responsible for completing the child intake. Sliding fee scale form needs to be completed as well.  

Adult Intake Form needs to be completed. Sliding fee scale form needs to be completed.

Child Intake Form needs to be completed for each child involved in family therapy. Child Intake Form needs to be completed by each parent unless one parent has sole legal custody then that parent is responsible for completing the child intake. Sliding fee scale form needs to be completed. 

Adult Intake Form for the adult participating in reunification therapy. Child Intake Form needs to be completed for each child involved in reunification therapy Child Intake Form needs to be completed by each parent unless one parent has sole legal custody then that parent is responsible for completing the child intake. Adults paying the fee need to complete sliding fee scale form. 

  • Reunification therapy allows families that have been separated for some time to come together to work through past issues and rebuild their bond. It can be seen as a combination of family therapy and supervised visits.  

Both adults need to complete an Adult Intake FormEach adult needs to complete sliding fee scale form. 

Parent that requires the visits need to complete an Adult Intake Form. Please provide the contact information for the placement of the children. Adult needs to complete sliding fee scale form. 

  • Therapeutic visitation is similar to traditional supervised visits, except a therapist or someone that has a Master’s level of education is supervising the visit.

Please call or email Kris Peters at 816-260-6982 then press 2 or  krisp@epkc.org