Special Needs Child Abuse Questionnaire

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Father’s Name

Father’s Email

Father’s Phone Number

Mother’s Name

Mother’s Email

Mother’s Phone Number

Child’s Name

Child’s Birthdate

School Where the Alleged Incident Occurred

Date the Alleged Incident Occurred

At the time of the alleged incident, who was your child’s teacher?

Child’s Teacher’s Name

Who was your child’s alleged abuser at the school?

Child's Alleged Abuser’s Name

What type of abuse did your child experience?

Physical Abuse
Emotional Abuse
Sexual Abuse

Did you report the incident to any of the following?

School Administration
Police
Medical Personnel

Please provide more details

If you told anyone above about your child’s abuse, what steps were taken by the school, if any? What was their reaction? Was there anything done?

Response by the School

Did you notice any changes in your child's behavior after the incident occurred?

Behavioral Changes

Is there anything else you would like to share about your child’s experience with abuse?

Additional Factors

Where there any witnesses to the alleged abuse? If yes, please provide information about these individuals.

Witnesses

Did you seek any medical or psychological care for your child following the alleged abuse? If yes, please provide information regarding the type of medical or psychological care received.

Describe Post-abuse Care

If medical or psychological care was received, please provide the name and address of each of the medical providers

Care Providers’ Information

The PF Law Firm represents parents and guardians of children who suffered abuse at their school. We understand the sensitive nature of these cases and work closely with our clients to obtain just compensation and require the school districts to undertake action to prevent other children from being abused in the future.

If you have any questions or require additional information about this case, please don't hesitate to get in touch with attorney Anastasia Palivos.

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