F.I.Request for MDT Partners

This page is for Multi-Disciplinary Partners ONLY. No requests for services from those unaffiliated with a Multi-Disciplinary Team will be scheduled as Forensic Interviews and Forensic Medical Exams are only scheduled by Law Enforcement and/or DFCS.

If you have concerns regarding the safety of a child, please call 911 and/or 1-855-GA-CHILD to connect with the Department of Family and Children Services.

Request a Forensic Interview

Case Number

Investigator's Email Address

Victim's DOB

Agency Name

Victim's First Name

Custodial Caregiver's First Name

Investigator Name & Contact Info

Victim's Last Name

Custodial Caregiver's Last Name

Custodial Caregiver's Phone Number

If same day service is needed
please call 706.278.4769

Is DFCS involved?

Yes

Who will be bringing the child to the Forensic Interview?

Custodial Caregiver

DFCS

Foster Parent

Other

Please select any applicable diagnoses or accommodations needed by the victim and/or the custodial caregiver.

Autism

Cognitive Delay

Limited Mobility

Translation (Other)

Speech/Hearing

Previous Victimization

Translation (Spanish)

Currently Detained

Other

Caseworker's Name

County

Caseworker's Phone Number

Caseworker's Email Address

Alleged Offender's Name

Date of last contact between Victim and Alleged Offender

Alleged Offender's DOB

Alleged Offender's Relationship to Victim:

Is the Alleged Offender a household member with the victim?

Yes

Is the Alleged Offender in custody?

Yes

Please use the space below to provide any necessary case details.

By checking here, you're acknowledging that you do not need same day services provided by The GreenHouse CAC/SAC and that you understand same day services requested by LE and/or DFCS can only be scheduled by calling 706.278.4769.

By checking here, you acknowledge it could take up to 24 hours for your request to be processed and scheduled unless you choose to call The GreenHouse CAC/SAC at 706.278.4769.

By checking here, you acknowledge that a representative from your agency is required to be present during the forensic interview(s) requested; this applies to both LE and DFCS without exception. FIs will not be conducted without LE and/or DFCS present.

P.O. Box 983 Dalton, Ga. 30722

F.I.Request for MDT Partners

Request a Forensic Interview

If same day service is needed please call 706.278.4769

Please use the space below to provide any necessary case details.

If same day service is needed
please call 706.278.4769