Intake Checklist

To apply for legal assistance, you (the client) will need to call our office at 1-877-402-2299. With your permission, someone can be on the line with you to help you place the call. Our screener will conduct an interview to get basic information about you and your legal problem. 

If it is determined that you are eligible for our services, the screener will conduct a complete intake, asking more in-depth questions about you and your case. This process can take up to 45 minutes. Your case will then be referred to a CLRP staff member who may give you advice only or may represent you at administrative hearings or in court proceedings.

If you are not eligible to receive our services, we may be able to refer you to other agencies or resources that can provide legal assistance.

To best provide you with the best possible intake experience, please have the following information available:

General Information:

• Name, Address, Telephone number
• Monthly source of income and amount
• Address and telephone number of where you currently reside (including psychiatric hospitals)
• Name of mental health provider

Housing Issues:

• Name of landlord or landlord’s attorney and contact information
• Copy of lease
• Copy of all relevant paperwork- Notice to Quit, Pre-Termination Notice, Summons and Complaint, rent receipts, correspondence, copies of complaints filed, copies of inspections, relevant photos.

Social Security Appeal:

• Social Security number
• Mother’s Maiden Name
• Copy of Denial and all other SSA Correspondence
• Mental Health History including diagnosis, provider and treatment histories- including hospitalizations, current medications
• Work history for the past 15 years
• Educational history
• Conservator information (if applicable)
• Incarceration history (if applicable)
• Residential program history (if applicable)

Employment Discrimination:

• Employer name and contact info
• Date of adverse job action (Termination, Demotion, Failure to reasonably accommodate)
• Reason given by employer for adverse job action
• Employer’s knowledge of disability
• Position title, description and essential job functions
• Disability name and description of impairment
• Health History including diagnosis, provider and treatment histories- including hospitalizations, current medications
• Understanding of how disability limits major life activities
• Medical Records
• How did the employer discriminate?
• Remedy sought (What do you want?)
• Has a CHRO complaint been filed?

Inpatient Related:

• Reason for admission
• What is the issue?
• Who is involved?
• Remedy sought (What do you want?)
• Legal Status
• Are there criminal charges?
• Who is your community mental health provider?
• Conservator information (if applicable)
• Prescribed meds
• Are there special needs (physical, language, cultural, etc)
• Is anyone else helping with the problem? Who? What have they done?
• What have you done to resolve your issue, if anything?
• Did you talk to your treating psychiatrist, nurse, social worker?

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