Request Services - Carroll County Child Advocacy Center

Request Services

For every service requested a law enforcement incident report is now required.

Type of Service Requested*
- Forensic Interview only
Child's Name:*
First Last
Choose One:*
Date of Birth:*
Age:*
Gender:*
Special Needs:
Care Giver's Name:*
First Last Suffix
Care Giver's Phone:*
Date of Referral:*
Date Format: MM slash DD slash YYYY
Agency or Person Making Referral:
Investigating Law Enforcement Agency:*
Investigating Law Enforcement Representative:*
First Last Suffix
Law Enforcement Rep. Phone (C):
Law Enforcement Rep Email*
If DFCS Involved?*
DFCS Representative:
First Last Suffix
DFCS Representative Email
DFCS Rep. Phone (C):
Allegations:*
Preferred Interview Dates and Times:*

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