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Feel free to leave us your contact information and we will get back to you as you instruct.
Your First Name (required)
Your Last Name (required)
Your Zip Code
Your Email (required)
Your Phone Number
What is your relationship with the children?
Have you had a psychological evaluation?
How did you hear about Attorneys for Children?
***The alleged perpetrator is the person and/or organization named as the suspected abuser by your supporting documentation.***
Name of Organization
Perpetrator's relationship to children (Staff, Teacher etc)?
Did you or someone else contact your local law enforcement agency?
If YES, please answer the following:
Law Enforcement Agency
Name and contact number of officer
Did law enforcement file charges against the alleged perpetrator?
Is there a pending criminal case?
Did you or someone else contact CPS?
Child First Name
Child Last Name
Child's date of Birth
Allegation of what type(s) of abuse:
Has the child been examined by any other doctor?
Has the child had a psychological evaluation?
Psych Exam Date
Is the child attending ongoing therapy?
Has the child made disclosures of abuse to his/her therapist?
Therapist Exam Date