2 minutes to complete
Any person who is a victim of domestic violence or has reasonable grounds to believe that he or she is in imminent danger of becoming a victim of domestic violence may file a report.
What is your relationship with the person who has been abusing you?
How long have you been in this relationship?
How often does the abuse occur?
What are the main types of abuse that you have experienced?
Describe the impact of the abuse on your life?
Are you afraid of the person who has been abusing you?
Have you been injured as a result of the abuse?
Have you been forced to do things against your will?
Has the abuse affected your ability to work or go to school?
Have you been forced to leave your home as a result of the abuse?
Are you in danger of being deported as a result of the abuse?
Have you been threatened with violence if you try to leave the relationship?