Crime Victim Survey

Categories of Crime: Child Victim of  Physical Abuse -  Child Victim of Sex Abuse - Victim of DUI/DWI - Victim of Domestic/Family Violence - Adult Victim of Sex Abuse - Elder Abuse - Adult Molested as a Child - Survivors of Homicide Victims - Robbery/Larceny - Assault (including gun violence) - Child Pornography - Hate Crime - Burglary - Harassment/Stalking - Motor Vehicle/Other - Identity Theft/Fraud/Financial Crime - Arson - Order of Protection Violation - Bullying - Human Trafficking - Teen Dating Violence - Other Victim of Crime not listed 

Client Age Required

Ethnicity Required

Gender Required

Date Required

Have you ever been the victim of a crime? Required ** NoneYesNo

Type of crime

Age now

Age at time of crime

Have members of your family been victims of a crime? Required ** NoneYes No

Type of crime

Age at time of crime

Age now

What services have you and/or your family received from Saratoga Center for the Family? Required

Mental Health Counseling

Child Advocacy Center

Community Presentations or Outreach Services

Safe Harbor Services

Prevention & Education Groups (Anger Management, Child Custody Stress Prevention, Parenting)

Victim Advocacy Services

No Services at This Time

Waiting For Services to Begin

Currently Seeking Services For:

Would you like someone to contact you about victim services? Required ** NoneYes No

If you would like to be contacted about victim services, please provide your name, phone number (with area code), and email address:

Please type the letters and numbers shown in the image. Click the image to see another captcha.

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