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Protective Order Questionnaire

The following questionnaire is to be completed in order to determine if you qualify for a protective order.

1. YES OR NO... Is the person from whom you seek protection a member of your family, a member of your household or someone you have or are currently dating?
DA-NO-01
DA-YES-PROCEED
2. YES OR NO... Has the person from whom you seek protection physically hurt you or threatened to hurt you?
DA-NO-01
DA-YES-PROCEED
3. YES OR NO... Are you in fear that the person from whom you seek protection may hurt you again?
DA-NO-01
DA-YES-03