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Social Services Help

Report Abuse Neglect or Exploitation

You may call us at the numbers below, or use the on-line form to report suspected abuse, neglect or exploitation. For more information on what abuse, neglect or exploitation is, please visit our Abuse, Neglect and Exploitation page.

Note: Any information you provide will remain confidential, including the fact that you submitted a report. You may complete the form without including your contact information. It is, however, very helpful to us if you do provide us with a way to get in touch with you if we have any additional questions. Please complete the form to the best of your ability. If you do not know the answer to a question, leave it blank.

To report abuse, neglect or exploitation, call:

• Nationwide 24-hour, toll-free 1-800-624-8404
• TTY (during business hours) 1-800-624-8404
• TTY In-State (after hours) 1-800-963-9490
• TTY Out-of-State (after hours) 207-287-3492

Report Form

 ^*Information about you: 

Your Name:
Phone:
Email:	(If you enter an e-mail, a confirmation e-mail will be sent to you with the details of your report)
Address:
What is your relation to person being abused/neglected/exploited:

^*Note: This information is optional, but the more you provide the better we will be able to investigate the problem.

 Information about the person being abused/neglected/exploited: 

Their Name:
Phone:
Address:
Gender:	Male    Female
Age:	18 - 30   30 - 40   40 - 50   50 - 60   60 - 70 Over 70
Mental Status:	Appears normal - alert and coherent Confused and disoriented Appears to be losing memory Depressed/suicidal Incoherent/unable to communicate Don't know Note: You can select multiple options by holding your <Ctrl> button down while making your selections. Feel free to add details in the Comments section.
Capacity/Dependency:	This person needs help from others with: Meal preparation Transportation Shopping Mobility Finances/money management Note: You can select multiple options by holding your <Ctrl> button down while making your selections. Feel free to add details in the Comments section.
Type of problem:	Abuse   Neglect   Exploitation
Description of what is going on:	Please provide a description of what is happening that you believe is abuse, neglect or exploitation.

 Information about the person committing the abuse, neglect or exploitation: 

Their Name:
Address:
What is their relation to the person being abused/neglected/exploited:

Additional Comments:

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