Anyone who is a victim of domestic violence or has witnessed domestic violence can fill out a domestic violence victim intake form.
What is your name?
What is your current address?
What is your phone number?
What is your email address?
What is your date of birth?
What is your current relationship status?
What is your employment status?
Do you have any children? If so, how many and what are their ages?
What are your hobbies and interests?
Tell me about your family.
Tell me about your relationship with your partner.
When did the abuse start?
Describe the abuse
How often does the abuse occur?
What is the nature of the abuse?
Is there any history of domestic violence in your family?