Clergy Abuse Survivors

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Abuse Questionnaire

All information is kept confidential and anonymous unless you request to be contacted by our local Louisiana attorney or submit your contact information

Step 1 of 4

25%

Were you or a loved one sexually abused by someone affiliated with a church or clergy member in or around the Baton Rouge or Lafayette, Louisiana areas?(Required)

Loved one name

Is your loved one deceased

Please specify the Louisiana Parish(es) where the abuse took place (select all that apply)(Required)

Acadia

Allen

Ascension

Assumption

Beauregard

Calcasieu

Cameron

East Baton Rouge

East Feliciana

Evangeline

Iberia

Iberville

Jefferson Davis

Lafayette

Livingston

Pointe Coupee

St. Helena

St. James

St. Landry

St. Martin

St. Mary

Tangipahoa

Vermilion

West Baton Rouge

West Feliciana

None of the Above

Was the perpetrator someone in an official capacity at a church or religious institution — such as a clergy member, staff, or volunteer — or a fellow parishioner?(Required)

Please write your (loved one’s) age at the time of abuse(Required)

Approximately what year did the abuse start?(Required)

Approximately what year did the abuse end?(Required)

Are you able and willing to provide identifiable details of the perpetrator and witnesses and/or individuals confided in regarding the abuse where applicable?(Required)

Are you currently represented by another attorney or have you signed any documents with another attorney for this matter?(Required)