Moxie Inc.
  • Home
  • Our Team
    • Dr. Kirsten Lysne
    • Peggy Cottrell
    • Michael Goldfarb
    • Dr. Julie McKay
    • Matthew Shore
    • Administration
  • Coaching & Therapy
  • Dispute Resolution
    • SENE
    • Mediation
    • Child Inclusive Mediation
    • Parenting Plan Evaluation
    • Parenting Consulting
    • Parenting Time Expediting
    • Expanded Evaluative Mediation
    • ADR Concierge
  • Contracts & Forms
  • Contact Us
    • Payments
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Contracts & Forms

Our most frequently requested contracts are available for download below. Feel free to use and review them, and don’t hesitate to call if you have questions about any of the content.

 

Kirsten Lysne, PHD, LP


  • Coaching Agreement 
  • Consulting Expert Agreement
  • Mediation Agreement
  • Child Consultant Agreement
  • Therapy Agreement
  • Release of Information Form - HIPAA 
  • ADR Concierge Agreement & Registration

Michael Goldfarb, MSW, LICSW


    • Child Consultant Agreement 
    • Coaching Agreement
    • Parenting Plan Evaluation Agreement
    • Mediation Agreement
    • PC Fee Agreement
    • Release of Information Form - HIPAA

Matthew Shore, MSW, LICSW


  • Child Consultant Agreement
  • Coaching Agreement
  • Parenting Plan Evaluation Agreement
  • Mediation Agreement
  • PC Fee Agreement
  • PTE Agreement
  • Release of Information Form - HIPAA

Dr. Julie McKay, Psy.D., LP


  • Coaching Agreement 
  • Mediation Agreement
  • Release of Information Form - HIPAA 

Services with Multiple Providers


  • Child Inclusive Mediation Agreement 
  • SENE Agreement
  • SENE Confidentiality Agreement
  • Expanded Evaluative Mediation Agreement

Links


  • Parenting Consultant Stipulation & Order on Mediation Center Website

Forms


  • Payment Remittance Form

Contact Us

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(763) 444-2240



(763) 444-2241

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P.O. Box 14416, St. Paul, MN 55114

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Dr. Kirsten Lysne

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Michael Goldfarb

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Matthew Shore

For scheduling and all other inquiries:

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Front Desk

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