Home
About
Practice Areas
Practice Areas in Chinese
Insurance Bad Faith
Product Liability
Wrongful Death
Brain Injury
Bicycle Accidents
Motorcycle Accidents
Truck Accidents
Taxi/Uber/Lyft Accidents
Food Poisoning
Government Liability
Construction Site Accidents
Premises Liability
Results
Media
Contact
Submit Abuse Form
Submit Personal Injury Form
Fee
Home
About
Practice Areas
Practice Areas in Chinese
Insurance Bad Faith
Product Liability
Wrongful Death
Brain Injury
Bicycle Accidents
Motorcycle Accidents
Truck Accidents
Taxi/Uber/Lyft Accidents
Food Poisoning
Government Liability
Construction Site Accidents
Premises Liability
Results
Media
Contact
Submit Abuse Form
Submit Personal Injury Form
Fee
Child Abuse Submission Form
Fields marked with
*
a
re required
Your submission will be kept confidential
*
Indicates required field
Your Name
*
First
Last
Child's Name
*
First
Last
Child's Date of Birth
*
mm/dd/year
Phone Number
*
Your Email
*
Child's Disability, If Any
*
Date of Incident(s)
*
Incident(s) Reported to the Police or CPS?
*
Yes
No
If Reported, Date of Reporting
*
mm/dd/year
Date Parent/Guardian First Learned of Incident(s)
*
If Reported to the Police or CPS, Who Reported It?
*
Describe Incident(s)
*
Describe Any Changes Observed in Child's Behavior
*
School District
*
Perpetrator's Name
*
First
Last
Photographs of Injuries Available?
*
Yes
No
School, Day Care, Camp, Scout or Other Institution's Name
*
Perpetrator's Relationship to Your Child
*
Disclaimer: By submitting this form, I understand that it does not establish an attorney-client relationship.
*
I have read and understand the disclaimer
Submit