There isn't a form for this. A motion particular to your circumstances must be filed with the Court, with a proposed order. If the Court grants the motion it will set a hearing -- usually within a couple of weeks -- and you will have to have the motion, order and notice of the hearing served on the custodial parent.
You would be well advised to consult with an attorney. You have specific legal standards to meet, and courts prefer to avoid ex parte orders because of constitutional due process concerns.
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