Axt Legal Consultation Questionnaire

Consultation Intake Form

Please tell us about your current situation. If my office is able to assist you, we will contact you to schedule a consultation. In the event we are unable to assist you, we are happy to provide a referral to another resource who may be able to help you.
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Student's Name*

First NameLast Name
Student's Birthdate*

MonthDayYear
Date
Student's Grade Level*
Current School of Attendance*
School District*
Does Student Have an IEP or 504 Plan?*

IEP504 PlanNeither
Student's Eligibility Category(ies)?

AutismOther Health ImpairmentSpecific Learning DisabilitySpeech Language ImpairmentEmotional DisturbanceIntellectual DisabilityOther
Student's Disability*
Please Describe Your Concerns Regarding Your Child's Education*
What Resolution Do You Seek In This Case?*
What Type of Service Are You Interested In?*

I just have questions and need guidance (consultation only)I am looking for an AdvocateI am looking for an AttorneyOther
Referral Source*
Who May We Thank For Referring You?
I understand that by requesting a consultation, there is no guarantee that Axt Legal will accept my case. I also understand any opinion or advice given by Axt Legal is opinion only, based on the limited facts provided, and is cursory, non-binding, and not an absolute statement of law. Legal representation, if offered, requires a separate contract and payment.
Should be Empty:

Consultation Intake Form