RDS Sign-Up Form

Please enter your information below so that we can begin to provide services.  We are here for you!

  First Name:
  Last Name:
  Male Female

Situation you're going through: 

Abuse and/or Harassment: 

Yes No


Yes No

Custody Dispute: 

Yes No

Property Dispute: 

Yes No
  Mobile Phone:
  Home Phone:
  Street Address:
  Address (cont.):
  Zip/Postal Code:
  Email Address where you want to receive your reports: 

Do you have an attorney? 

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Do you want a copy of your reports sent to your attorney? 

Yes No

Attorney's Email:

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Revised: 04/27/16