LeDuc Montgomery LLC
2210 W Main Street, Suite 107-328
Battle Ground, WA 98604
+1 (704) 702-6934
This intake form is for prospective clients with civil rights matters who are currently housed in a prison or jail facility in Oregon.
If AICS s do not have an email address, use alicia@leducmontgomery.com.
Contact information: Inmate Contact Info
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Upon submission, a copy of this form will be sent to the primary email.
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Primary
Default address false
Add address
Date First Contact Mailed
Inmate SID Number
What prison or jail are you currently housed in?
Prison
Jail
Other
Which facility? Federal, state, or county?
What prison are you currently housed in?
Select an option
Not currently in an Oregon state prison facility
Coffee Creek Correctional Facility (CCCF)
Columbia River Correctional Institution (CRCI)
Deer Ridge Correctional Institution (DRCI)
Eastern Oregon Correctional Institution (EOCI)
Oregon State Correctional Institution (OSCI)
Oregon State Penitentiary (OSP)
Powder River Correctional Facility (PRCF)
Santiam Correctional Institution (SCI)
Snake River Correctional Institution (SRCI)
South Fork Forest Camp (SFFC)
Two Rivers Correctional Institution (TRCI)
Warner Creek Correctional Facility (WCCF)
What jail are you currently housed in?
Select an option
Baker County Jail
Benton County Jail & Corrections
Benton County Juvenile Facility
Clackamas County Jail
Clackamas County Juvenile Detention Center
Clatsop County Detention Center
Clatsop County Juvenile Detention Center
Columbia County Jail
Coos County Juvenile Detention Center
Coos County Sheriff's Jail
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Curry County Sheriff's Jail
Deschutes County Adult Jail
Deschutes County Juvenile Detention Center
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Douglas County Juvenile Detention Center
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Jackson County Juvenile Detention Center
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Josephine County Juvenile Detention Center
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Klamath County Juvenile Department
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Lane County Juvenile Detention Center
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Lincoln County Juvenile Detention Center
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Malheur County Correctional Facility
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Marion County Juvenile Detention Center
Marion County Work Release Center
Morrow County Jail
Multnomah County - Wapato Facility
Multnomah County Court Holding Facility
Multnomah County Detention Center
Multnomah County Iverness Jail
Multnomah County Juvenile Detention Center
NORCOR Adult
NORCOR Juvenile
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Sherman County Jail
Tillamook County Jail
Umatilla County Correctional Facility
Union County Correctional Facility
Wallowa County Sheriff's Office
Wasco County Jail
Washington County Jail
Washington County Juvenile Detention
Wheeler County Jail
Yamhill County Jail
Yamhill County Juvenile Detention Center
Not currently housed in a jail
Do you expect to be released from custody within 1 year?
Yes
No
I don't know
Have you filed a lawsuit against Oregon Department of Corrections (ODOC) before?
Yes
What was the result?
No
I don't know
What date did the incident/harm/injury occur? If there were multiple incidents, what is the date of the most recent incident?
Where did the incident/harm/injury occur?
Did you file a grievance about the incident?
Yes
No
I don't know
Was your grievance substantiated or denied?
Substantiated
Denied
Other
If your grievance was denied, have you filed an appeal?
Yes
No
I don't know
Did you file a tort claim notice yet?
Yes
No
I’m not sure
Have you filed an existing lawsuit for this incident?
Yes
What is the case number?
No
I'm Not Sure
What issues are you contacting us about?
Physical Assault
Sexual Assault
Bias or Discrimination (Any Basis)
Excessive Use of Force by Staff
Retaliation
Medical Care Issues
ADA - Americans with Disabilities Act Issues
Failure to Protect from Harm
Excessive Punishment
Chemical Spray
Access to Programs or Law Library Resources
Ramos/Non-Unanimous Jury Verdict
Other
How have you been harmed by this incident?
Serious Physical Injury (broken bone, surgery, permanent damage)
Mild Physical Injury (bruising, cut, scrape, bloody nose, temporary wound that has healed)
Required hospitalization or outside medical transport
Financial costs (fines, fees)
Loss of Privileges (housing, removal from program, loss of job, etc.)
Retaliation (put in segregation, write up, threats of harm, actual harm, transfer to another facility, verbal threats, written threats, other)
Commissary (purchased first aid, medications, self care materials from commissary in connection with the incident)
Damage to Personal Property (Taking property, losing property in transfer, damaging property, breaking property)
Emotional Distress (Going to BHS, fear, anxiety, trouble sleeping, loss of appetite, PTSD, nightmares, crying, sadness, depression, chronic stress)
Sexual Abuse (rape, sexual touching, non-Consentual touching, solicitation, sexual harassment)
Other
Were there any eye-witnesses to the incident/harm/injury?
No, just me and the person doing it
Yes, other AICs
Yes, other prison staff
Yes, other third parties
What correctional facility staff were involved? (Name, Rank/Title, What their role in the incident was)
What other adults in custody were involved? (Name, SID, Contact info, What their role in the incident was)
Tell me the short version of what happened:
Anything else that is important to know?