Kindezi at Gideons Elementary – Media Center
837 Welch St. SW, Atlanta, GA 30310
3:00 PM – 5:00 PM
Please complete the form below to request an appointment.
An AVLF staff member will reach out to you to verify your information
and complete a full program intake.
Your appointment is not confirmed until that time.
Your
preferred
time for
Wednesday, September 16, 2026
:
3:00pm
3:30pm
4:00pm
4:30pm
Your Contact Information
First Name
Last Name
Street Address
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State
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Different engagement address
Check here if the address of the property with the legal issue is
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address above.
Property Address
Street Address
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Do we have your permission to contact you via text message?
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Household Information
# of adults in household
# of children/minors in household
Total household yearly income
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.00
Source(s) of Income (check all that apply)
Alimony or Spousal Support
Disability- Other
Disability- Social Security (SSDI)
Disability- Veteran
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Demographic Information
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Do you have a disability?
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Type of disability?
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Vision impaired
Hearing impaired
Limited mobility/Physical disability
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Does any other member of your household have a disability? If so, check this box.
Briefly explain the situation needing an attorney consultation:
Optional Health and Safety
Sometimes people cope with stress, trauma, or unsafe situations by misusing substances. Is this part of your experience, the experience of your family, or a household member?
Yes
No
If yes, who has misused substances? (Select all that apply)
You
A household member
Your partner or former partner
Other
Prefer not to answer
Is the misused substance an opioid such oxycodone, fentanyl, heroin, methadone, hydrocodone, morphine, percocet, tramadol, Vicodin, or similar medications?
Yes
No
I'm not sure
Prefer not to answer
If yes, which of the following best describes your situation? (select all that apply)
Opioid use has affected me personally
Opioid use has affected my partner or former partner
Opioid use has affected a household member
Other
Are you currently:
In recovery
Seeking treatment or support
Interested in learning about available resources
Not seeking support at this time
Prefer not to answer
Is the legal problem/issue caused or impacted by opioid use?
Yes
No
Prefer not to answer
Thank you for trusting us with that information. We understand these experiences can be personal and difficult to discuss. Your response helps us better understand any barriers, safety concerns, or support needs that may be impacting you or your family.
Would you like information about opioid-related resources?
Yes
No
Prefer not to answer