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Domestic Violence / Injunction Intake

Domestic Violence / Injunction Intake

This form carries the detail these cases need. Take your time — and if you’re in immediate danger, call 911.

These submissions are reviewed promptly given how time-sensitive they are. If you are in immediate danger, call 911. National DV Hotline: 1-800-799-7233.

Thank you for your response. ✨

Your information

First name(required)

Last name(required)

Cell phone(required)

Email(required)

County (Florida)(required)

Residential address

Marital status

The case

Are you filing, or responding to a petition?

I'm filing I'm the respondent

Have you been served?

Yes No

If served — case number

If served — date served

YYYY-MM-DD

Type of injunction(required)

The other party

Other party’s name(required)

Relationship to you

Other party’s address

Other party’s phone

Other party’s email

Children

Are minor children involved?

Yes No

If yes — children’s names, ages/DOBs, count

What happened

Describe what happened(required)

Was law enforcement involved?

Yes No

If yes — police involvement details (report #, agency)

Do you have evidence (texts, photos, records)?

Yes No

If yes — describe the evidence

How did you hear about us?

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