What would you like done with the information provided?

Who is the abuser?

When did it happen?

Where?

In which city?

Abuser’s Gender, Race, Age, Height, Looks, Tattoos, etc 

Abuser’s Name

Phone Number/ Email:
**We will not give out the full phone number or contact this person

If a vehicle was involved, vehicle type (e.g., sedan, truck), make (e.g. Ford,Audi), license plate, colour

What happened?

Would you like support from SWAN in regard to this incident? (e.g., referral to a health provider, emotional support, legal information, reporting to police, etc.)
YesNo

If yes:

Is there anything else you would like to tell us?

If you do not want to report to the police, why?