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The information that you provide in this document is intended to be kept confidential between you and Amanda Silver as it is provided as part of a confidential dispute resolution process. No party may seek disclosure of what the other wrote on their intake forms and I will keep your information confidential.

There are however exceptions to confidentiality in family dispute resolution including my duty to report to
a Children’s Aid Society if a child is at risk of harm; my duty to warn a person if there is a threat to their
safety; or if a judge orders me to disclose information to the court.

By completing this intake form you agree to these terms. Please ask me if you have any questions.

NOTE: Each party is required to complete and submit their own form

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