Domestic Violence

Domestic Violence
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date

MonthDayYear
Date
Which Court is your order through?
Please upload your completed Consent to Treatment and Request for Record forms.

Cancelof
Tuesday classes are designated for women only.
Wednesday classes are designated for men only.
Select your date
Before attending your first class, you are required to complete an initial assessment with a domestic violence counselor. Once this assessment is completed, you will be eligible to attend classes. Please note that each session is paid for individually on a weekly basis.

Session

Please select this area if you are already had your first initial assessment.

$36.00 Quantity

Initial assessment

Please select this area to start your first steps in attending the DV program

$60.00 Quantity

Total

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