Human Rights Legal Referral Questionnaire

Please provide information about the treatment you experienced and what you would like help with from a lawyer or paralegal on our Preferred Legal Provider Network. LegalPro Connect uses your answers to prepare a factual referral summary. You do not need to prove discrimination or know which law applies to complete this questionnaire.
Name

First NameLast Name
Address

Street Address

CityProvincePostal Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Part 1: About the treatment you experienced
Do you believe you were treated unfairly because of a personal characteristic?
Which personal characteristic or characteristics do you believe were connected to the treatment? Select all that apply.
If Other, please describe the personal characteristic.
If disability is involved, is it a physical condition, a mental health condition, or both?
Part 2: Where it happened and what occurred
What setting did the incident happen in?
If Other, please describe the setting.
What treatment or negative outcome did you experience? Select all that apply.

Other
Briefly describe what happened, including any treatment or outcome not listed above.
Did this result in a financial loss or a negative impact on your health or dignity?
Briefly describe any financial loss or impact on your health, dignity, or daily life, if applicable.
Part 3: Why you believe the treatment was connected
Why do you believe the treatment was connected to the personal characteristic or characteristics you identified? It is fine if you are not sure.
Did anyone make comments or take actions that you believe related to those personal characteristics? If so, briefly describe what was said or done and by whom.
Were other people in a similar situation treated differently from you?
If Yes, briefly describe how their treatment differed and any relevant similarities or differences in their circumstances.
Part 4: Dates, location, and any existing proceedings
When did the most recent incident occur (if known)?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Briefly describe when the incidents occurred and whether the treatment is ongoing. Approximate dates are fine if you do not remember exact dates.
In which province or territory did the events occur? If more than one, please list them.
Have you filed a complaint, application, grievance, or court case about these events?
If Yes, please identify where you filed, when you filed, any file number, and the current status or outcome, if known.
If this concerns employment, do you know whether your employer is federally regulated?
Name of the employer, landlord, service provider, or other organization involved (if known).
Does any letter, notice, tribunal, commission, or court document give you a deadline? If so, enter the date and what it asks you to do.
Upload any relevant letters, notices, decisions, or correspondence you would like a lawyer or paralegal on our Preferred Legal Provider Network to review (if available).

Cancelof
What would you like help with from a lawyer or paralegal on our Preferred Legal Provider Network?
Are you currently represented by a lawyer or paralegal in this human rights matter?
Are there any accessibility, communication, language, or other support needs you would like a lawyer or paralegal on our Preferred Legal Provider Network to know about?
Legal Disclaimer

LegalPro Connect provides referral and information services, not legal advice or representation. We do not determine whether discrimination occurred or assess the legal merits of your matter. Submitting this questionnaire does not guarantee a referral or acceptance by a lawyer or paralegal on our Preferred Legal Provider Network, create a lawyer-client or paralegal-client relationship, or meet, preserve, or extend any deadline. Any prospective representative will confirm whether they can assist, the scope of services, and applicable fees.
Legal Disclaimer acknowledgement
Consent to referral and information sharing
LegalPro Connect

First NameLast Name
Should be Empty:

Part 1: About the treatment you experienced

Part 2: Where it happened and what occurred

Part 3: Why you believe the treatment was connected

Part 4: Dates, location, and any existing proceedings

Legal Disclaimer