Javascript is required to load this page.
Page Loaded
Mobile Child Interviewing Lab Intake Request Form
Please fill out the following form, and we will contact you shortly to schedule an expedited forensic interview.
Have you reached out to your closest CAC?
Yes
No
Is this an urgent 'in-custody' case with charges pending?
Yes
No
Other
Referring Agency:
LAPD
LASD
DA
Other
Referrer's Information
Name
Phone
Email
Date Interview is Needed by (specify day):
Area(s) of Investigation:
Child Sexual Abuse
Domestic Violence/Physical Abuse
Homicide
Other (please specify)
Number of Children to be Interviewed:
1
2
3
4
5
6
7
8
9
10
Children's Ages:
1
10
2
11
3
12
4
13
5
14
6
15
7
16
8
17
9
18
Children's Primary Language:
Additional Notes/Comments:
Powered by Qualtrics