To report a bad date, either download the Bad Date Form (PDF) or fill out the form below:

  • Date Completed
  • SW's gender
    MFT
  • Description of Date
    Gender
    MFT
  • Age (approx)
  • Weight/Build
  • Height (feet)
  • Hair (colour/length)
  • Eye Colour
  • Ethnic Origin
  • Clothing
  • Distinctive Features (tattoos, beard, glasses, scars):
  • If more than one person, please describe:
  • Transportation
    License Plate
  • Make/Model
  • Colour
  • Style
    newoldsporty
  • Transmission
    standardautomatic
  • Doors
    24van
  • Distinctive Features (car seats, decals, radar detector, GPS, anything broken):
  • Incident
    Incident Type
    sexual assaultthreatsaggressionrobberyphysical assaultother
  • Other
  • Date
  • Time
  • How long did the incident last?
  • Where you met
  • Where it happened
  • The date wanted:
  • Weapon
    yesno
  • Weapon description
  • Were the police notified?
    yesno
  • By whom
  • Description of what happened
  • What can we do to help you?
    referral to Street Nurse for testingaccompany you to policefirst aid careother
  • Other
  • Please note contact information and name if you would like us to contact you for the above support.
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