Online Intake Form

(1) Call us at (803) 509-6552 between the hours of 9 a.m. and 5 p.m. Monday through Friday, OR
(2) Fill out the Online Intake Form below and we will call you as soon as possible to finalize the intake process.
For the intake process, we must communicate directly with the victim, not a third party.

If you have problems viewing the form, please email for assistance OR click this link and the form will pull up in a separate window.