Tangled Minds
720-383-7095
Child Custody Disclosure
We enjoy working with children and their families, but this does often come with custody agreements. Please note that we are bound by the legal agreements in place and must adhere to them. ALL patients under the age of 18 must have this form completed and returned, whether there is an agreement in place or not. Upon becoming a patient, you will be asked to formally disclose the following:
For any patient under the age of 18, please disclose any current custody agreements that may be in place. If a child has multiple guardians, Tangled Minds, LLC must be made aware and permissions must be received from all legal guardians over a child.
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Are you the legal guardian of the patient under the age of 18?
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Are you the legal guardian of the patient under the age of 18?
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Is there any court ordered custody agreement in place for the patient under the age of 18?
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Are there any other Guardians for the patient under the age of 18?
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If YES, please provide the other Guardian's name, address and phone number.
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Has the other Guardian approved care with tangled Minds, LLC?
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Please send a copy of this custody agreement to Tangled Minds, LLC via our secure email OR upload it to the portal.