Parenting Coordination Services Agreement

Parenting Coordination Services are provided by licensed family therapist Sarri Gilman.

All of your sessions will be facilitated by Sarri Gilman, LMFT.

The first parenting coordination session is scheduled with all children above the age of 5 years old, and both parents/guardians of the children.

The second session is with the parents of the children.

The purpose of parenting coordination is to:

1)      Identify disputed issues

2)      Reduce misunderstandings

3)      Clarify priorities

4)      Explore possibilities for problem solving

5)      Develop methods of collaboration in parenting

6)      Understand parenting plans and reach agreements about parenting issues to be included in parenting plan

7)      Comply with the Court’s order regarding guardianship and access to the child/ren.

The parenting coordinator may not modify any order, judgment, or decree. Any agreements made by the parties in the parenting coordination process must be reduced to writing, signed by parties and their attorneys, and filed with courts.

Parents/guardians will leave parenting sessions with written copies of the things they have agreed to in the session. If the parties want to take those agreements to attorneys, that is their option.

No subpoenas, citation, writs, or other process shall be served at or near the location of any parenting coordination session, upon any person entering, leaving, or attending any parenting coordination session.

In addition, the parenting coordinator may not:

1)      Be compelled to produce work product developed during the appointment as parenting coordinator

2)      Be required to disclose the source of any information

3)      Submit a report into evidence

4)      Testify in court

The parenting coordinator does have the legal obligation to report child, elder, or disability abuse or neglect.

A parenting coordinator shall submit a status report to the Court and to the parties and their representing attorneys every 60 days or as requested by the parties or the court. In the report, the parenting coordinator may give only the opinion regarding whether the parenting coordination should continue.

Confidentiality Policies:

I understand the information exchanged with the parenting coordinator will be held confidential by the parenting coordinator in accordance with HIPAA regulations and other federal and state regulations. If the service is being paid for by insurance, insurance payment requires some level of information sharing authorized by the clients. Insurance claims will be filed only if the participating parent requests insurance processing, is fully aware that a medical diagnosis must be provided, and has family therapy vs. individual therapy authorized by their insurance carrier.  Information will be shared with attorneys and other professionals in accordance with signed releases.

Financial Policies:

1. Prior to scheduling an appointment, a retainer of $300, must be sent to the therapist. Each parent participating in the appointment pays $150.  This retainer is used to cover any missed session or time spent coordinating with your attorney. If the retainer is unused, it will be returned upon completion of parenting coordination.
2. I understand that I am responsible for the cost of the session at the time of the session.  I understand the cost is $120/hour.   This cost is split between the parents in accordance with their financial agreement.
3. I am responsible for any insurance co-pay or deductible at the time of service.
4. Notice of rescheduling an appointment must be received 24 hours before the scheduled appointment to avoid being charged for the session.
5. Court testimony by a parenting coordinator is not allowed. However, if that agreement is violated and subpoena is issued, court testimony is not covered by insurance. Travel time, wait time, and court time will be payable by the party who issues the subpoena with a deposit of 4 hours required to be paid 24 hours before the hearing in order for the therapist’s clients to be rescheduled.

I have read the above description of parenting coordination services and the description of the service and financial policies. I agree to the parenting coordinator’s policies regarding confidentiality and fee payment as a participant in this service.

Date_______________    Client____________________________________________________

Date received____________  Parenting Coordinator__________________________________

                                                                                   Sarri Gilman, LMFT

Mail to: Sarri Gilman, LMFT  742 Suzanne Court,  Langley  WA 98260