New Client Registration Forms
Thank you for visiting The Toby Center. We know that many of you are seeking immediate and affordable assistance with supervised visitation, monitored child exchange and therapeutic interventions.
Kindly review our fee structure for the services below, and then please go ahead and complete your requests. We will be glad to speak with you about your concerns, service availability in your county, and answer any questions you may have! Reach out to me directly if you need services in your area!
With much appreciation,
Dr. Mark Roseman
Due to the nature of some forms needing a notary, return below forms to the Toby Center by scanning and emailing to clberko@aol.com, or faxing to 855-332-7321. Also, attach any court order for the service being requested.
Service Description and Fees
Service Request and Registration Documents
- New Client Service Request
- Joint Agreement Form
- Certificate of Income
- An Update for Our Client Families Regarding The Coronavirus (COVID-19)
- Please forward a copy of all court orders pertaining to visitation and all services requested
Service Intake and Contract Forms
- Child Intake Form (to be completed by custodial parent or guardian)
- Monitored Child Exchange Agreement
- Therapeutic Visitation and Reunification Intake
- Online Form: Supervised Visitation Intake Form
These are easily available and very effective when face to face visitations may not be available. Toby Center Family Monitors will help you maintain the contact with your children that research finds they require. Especially, your continuing contact will assure your children in this very challenging time.
Agency Referrals
Download your form(s) and then upload them here. If you have multiple files, upload them one at a time.
CONTACT FOR QUESTIONS
Claire Berkoff,
New Client Coordinator
EMAIL FORMS TO: clberko@aol.com
PHONE: 855-862-9236 X1
FAX: 855-332-7321
