Client Intake Form | Los Angeles Special Kids Attorney

DIFFERENT. NOT LESS.

We personally understand this is a very challenging time and you have many concerns and pressing questions about your child’s needs. Please be sure that we are absolutely committed to providing you with quality, tenacious and effective legal representation to maximize your child’s educational benefit and any regional center services required.

Please complete the form below to familiarize us with your child and your concerns and we will reach out to you and provide the assistance needed as soon as possible.

First Name
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Last Name
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Phone
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Email
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Street Address
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City
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Zip
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Do you require an interpreter?
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School Information
School
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District
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Student's First Name
Please enter your Student's First Name.
Student's Last Name
Please enter your Student's Last Name.
Birthdate (mm/dd/yyyy)
Please enter your Birthdate (mm/dd/yyyy).
Grade:
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Receiving district services?
Please make a selection.
If yes, please describe current services receiving
What are the current problems you are having with the District/Regional Center?
What services do you want our office to obtain for you?
Additional Information
Has there been a private assessment?
Please make a selection.
If yes, who gave the assessment?
What was the date?
Please enter your the date.
Have you had an IEP?
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Date of most current IEP
Please enter your the date.
Have you ever been represented by an attorney or advocate?
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Name of attorney or advocate?
Please enter your the name of attorney.
Are they currently providing you with services?
Please make a selection.