Report Elder Abuse Forms

Elder abuse is unacceptable anytime, anywhere.

A picture of a concerned elderly man's face. The forms below will allow you to help a senior who you may suspect is being abused. If you choose, it can be done anonymously. Either way, it is important to help.

Senior's Name
Address
City
Report Abuse Please give a description of abuse. OPTIONAL
Your Name
Your Phone Number

Caregivers and Health Professionals

Elder-care custodians, health practitioners, or employees of County Adult Protective Services Agencies who, within their professional capacity or within the scope of the employment, suspect an incident of abuse or neglect, MUST REPORT immediately by telephone and in writing within two working days to Adult Protective Services, Long-Term Care Ombudsmen Services, or to the police. IN CASE OF EMERGENCY, CALL 911.

Report of Suspected Dependent Adult/Elder Abuse Form (PDF download)

Financial Institutions

Effective January 1, 2007 all financial institutions and their affiliates are mandated reporters. Employees of financial institutions who, within their professional capacity, suspect an incident of financial abuse MUST REPORT immediately by telephone and in writing within two working days to Adult Protective Services, Long-Term Care Ombudsmen Services or to the police. IN CASE OF EMERGENCY, CALL 911.

Report of Suspected Dependant Adult/Elder Financial Abuse Form (PDF download)