All incidents must be reported to law enforcement or child welfare before a forensic interview can be scheduled. Only law enforcement or child welfare workers may complete this form. To report suspected child abuse, call the Child Abuse Hotline: 1.800.522.3511. If you believe a child is in immediate danger, please call 911 or your local law enforcement agency.
Complete the below forensic interview request form with as much detail as possible and Mary Abbott House staff will be in touch within 24 hours to confirm your request.
Name of Person Requesting Forensic Interview (Your name+agency)
*
Phone Number of Person Requesting Forensic Interview (Your number)
*
Please enter a valid phone number.
Email of Person Requesting Forensic Interview
*
example@example.com
Number of Children to be Forensically Interviewed. For 6+, please call the Mary Abbott House at 405.579.5800 to schedule.
*
Please Select
1
2
3
4
5+
Child #1 Name
*
Child #1 Age/Race/DOB/Gender/SSN
*
Child #2 Name
Child #2 Age/Race/DOB/Gender/SSN
Child #3 Name
Child #3 Age/Race/DOB/Gender/SSN
Child #4 Name
Child #4 Age/Race/DOB/Gender/SSN
Child #5 Name
Child #5 Age/Race/DOB/Gender/SSN
Has the child(ren) been previously interviewed?
*
Please Select
Yes
No
I'm not sure
Name of child(ren)'s school(s)
Name of adult(s) attending appointment with child(ren)
*
Attending adult's relationship to child(ren)
*
Attending adult's phone number
*
Please enter a valid phone number.
Summary of Allegation/Disclosure
*
Incident Location + Zip
Number of Suspects. For 5+, please call the Mary Abbott House at 405.579.5800 to schedule.
*
Please Select
1
2
3
4
5+
Suspect #1 Name
Suspect #1 Age/Race/DOB/Gender/SSN
Suspect #2 Name
Suspect #2 Age/Race/DOB/Gender/SSN
Suspect #3 Name
Suspect #3 Age/Race/DOB/Gender/SSN
Suspect #4 Name
Suspect #4 Age/Race/DOB/Gender/SSN
Suspect #5 Name
Suspect #5 Age/Race/DOB/Gender/SSN
Any suspect history with LE or DHS
Detective Name + Agency
Detective Phone Number
Please enter a valid phone number.
Detective Email
example@example.com
DHS Name + Agency
DHS Phone Number
Please enter a valid phone number.
DHS Email
example@example.com
Needs History (Check all that apply)
Drugs/Alcohol
Mental Illness
Mental Limitations
DV
Divorce/Custody
History with LE
History with DHS
Other
LE Case Number
DHS Case Number
Special Considerations?
Developmental Delays
Sexually Acting Out
Non English speaking
Special Needs
Other
Does the family speak English?
Please Select
Child(ren) and Caregivers speak English
Child(ren) speak English;Caregivers do not
Child(ren) and Caregivers do not speak English
Child(ren) do not speak English;Caregivers speak English
Is there anything we should know about this case?i.e. child has received medical, child is currently in counseling
Submit
Should be Empty: