You will be asked, but you do not have to reveal your name and address unless you want to come into shelter.
	Who referred you to us?
	Can you talk (safely, comfortably, privately) right now?
	Is your abuser present?
	Do you want us to call the police?
	Are you or your children hurt?
	Do you need assistance getting medical help?
	What is the trouble? (most recent incident; history of abuse)
	Abuser’s name/relationship to victim
	Does the abuser have weapons?
	Are drugs or alcohol used by the abuser?
	Does abuser have a psychiatric history?
	Is abuser on medications?
	Is Child Protective Services involved?
	Is there an Order of Protection current or pending?
	Is a court order pending for custody or divorce?
	Do you have transportation?
	Are your important papers together and accessible?
	Are you bringing children with you?
	Do you have prescription medications for yourself and your children?
	Are you employed?
	Are you receiving Public Assistance?
	Do you or your children have any medical needs or disabilities?
	Do you or your children have any substance abuse or mental health issues? (A “yes” answer does not disqualify you for shelter)