Moxie Inc.
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  • Our Team
    • Dr. Kirsten Lysne
    • Peggy Cottrell
    • Michael Goldfarb
    • Matthew Shore
    • Administration
  • Coaching & Therapy
  • Dispute Resolution
    • SENE
    • Mediation
    • Child Inclusive Mediation
    • Custody & Parenting Time Evaluation
    • Parenting Consulting
    • Parenting Time Expediting
  • Contracts & Forms
  • Contact Us
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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 

Peggy Cottrell, MA, LMFT


  • Child Consultant Agreement
  • Coaching Agreement
  • Mediation Agreement
  • PC Fee Agreement
  • PTE Agreement
  • Therapy Agreement
  • Release of Information Form - HIPAA

Michael Goldfarb, MSW, LICSW


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

Matthew Shore, MSW, LICSW


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

Services with Multiple Providers


  • Child Inclusive Mediation Agreement 
  • SENE Agreement
  • SENE Confidentiality Agreement

Links


  • Parenting Consultant Stipulation & Order on Mediation Center Website

Forms


  • Payment Remittance Form
  • Release of Information Form – General

Contact Us



(763) 444-2240



(763) 444-2241



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



Dr. Kirsten Lysne



Peggy Cottrell



Michael Goldfarb



Matthew Shore

For scheduling and all other inquiries:



Front Desk

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