Please note: We have created an abbreviated intake questionnaire to help us begin thinking about your potential case. Of course we will go into more detail with you directly, but this will help to start the dialogue. Also, we have found that by beginning the process it helps one to not feel so isolated and alone.
Please do not worry if you cannot answer all of the questions; just do the best you can.
1. Did the harassment occur at work, or in some other context?
2. Upon what basis do you believe you were discriminated against?
(Sex, race, color, religion, ancestry, national origin, actual or perceived sexual orientation, marital status, pregnancy status, age, disability, “whistle blowing,” or in retaliation for a complaint related to the above made against your employer)
3. When did the discrimination occur?
If over a period of time, approximately when was the first event, and when was the most recent?
4. Briefly describe what occurred.
5. Have you reported the discrimination to anyone? To whom? When?
6. Was any action taken by your employer, or by anyone in a position of authority?
7. Have any other people been discriminated against, or might have been discriminated against?
Were they of the same protected class as yourself? (See question above.)
8. In addition to your emotional damages, have you suffered any financial loss?
Approximately how much? (Loss of job, loss of benefits, demotion, lack of promotion, medical bills, etc.)
9. Have you sought any treatment?
(Doctor, therapist, counselor, etc.) Have you filed a disability claim? When?
Please fill out the form below to send us your responses in as a secure e-mail message. Again, all information you provide will be maintained in strict confidence. We will respond to your inquiry within 24 hours. Fields marked with an * are required.
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