Report Abuse Neglect or Exploitation

If you have an emergency or life-threatening situation that must be addressed immediately, please call 911.

Report Methods

1. If you are a Mandated Reporter you are required by law (22 M.R.S. § 3477) to call 1-800-624-8404 to make a report to Adult Protective Services.

2. If you are not a mandated reporter, you can call 1-800-624-8404 (24-hour, Toll Free) or Maine Relay 711 to report abuse, neglect, or exploitation or complete the online form below.

If you are concerned about someone under the age of 18, please call 1-800-452-1999 (Maine Relay 711 - TTY)

Online Report Form

All of the fields below are optional. Please remember that the more information you provide the better Adult Protective Services (APS) will be able to investigate.

Note: Providing as much information as possible allows APS to investigate more quickly. Please provide contact information so APS can follow up with any questions that are needed to investigate.

Are you a Mandated Reporter? Yes No

If you are a mandated reporter, you are required to call 1-800-624-8404 to make a report to APS (22 MRS §3477)

Information about you (the reporter):

Your Name:
Primary Phone Number:
Alternative Phone Number:
Email (for confirmation):
Your Address:
Your agency / facility name (if applicable):
Your relationship to the adult being abused, neglected, or exploited:

Information about the adult you are concerned about:

Information about the person committing the abuse, neglect or exploitation:

NOTE: If multiple perpetrators are involved, please list each name and related info separately in the "Multiple perpetrator info" field below.

Name:
Nickname(s) / Other names used:
Date of Birth:
If DOB is unknown, approximate age:	18 - 30 30 - 40 40 - 50 50 - 60 60 - 70 Over 70
Primary Phone Number:
Alternative Phone Number:
Gender:	Male Female
Living Arrangement:	Alone Homeless With Family Facility Group Home Shared Living Unknown Other
Home Address:
Current address (if different):
If name is unknown or the adult is homeless, please provide the adult's physical description:
Mental Status:	Appears normal - alert and coherent Confused and disoriented Appears to be losing memory Depressed / suicidal Incoherent / unable to communicate Don't know
Dependencies:	This person needs help from others with: (Select all that apply) Meal preparation Transportation Shopping Mobility Finances / money management
Adult's guardian (if applicable)
Guardian's Primary Phone Number:
Guardian's Alternative Phone Number:
Guardian's Address (if different):
Type of problem:	Abuse Neglect Exploitation
Please describe the alleged abuse, neglect, exploitation, or risk of abuse, neglect, or exploitation, with as much detail as possible (required)
Is the situation you described a one-time event, repeated issue, or constant situation? (Select one)	One-time event Repeated issue Constant situation
When did this event happen (list date or dates):
How do you know the information you described:
Does the alleged perpetrator(s) currently have access to the adult?	Yes No Unknown
Please list any other agencies you have notified regarding the situation you described (including, local law enforcement, DHHS Division of Licensing and Certification, etc.):

Name of Alleged Perpetrator:
Nickname(s)/Other names used:
Relationship to the Adult Victim:
Date of Birth:
If DOB is unknown, approximate age:	18 - 30 30 - 40 40 - 50 50 - 60 60 - 70 Over 70
Primary Phone Number:
Alternative Phone Number:
Home Address:
Current address (if different):
Physical description:
Multiple perpetrator info (if applicable):
Are there other individuals who may have more knowledge relating to your concerns that APS should be aware of? If so, please list names, phone numbers, and relationship to adult:
Other concerns (select all that apply):	biohazard(s) in home dangerous home structure pest infestation in home criminal activity / illegal drug use in home drug manufacturing in home untreated mental illness in home smoking and use of oxygen weapons in home aggressive animal(s) in home threats of violence made
Please provide additional comments related to all "Other Concerns" selected above:

Maine Department of Health and Human Services

Office of Aging and Disability Services

Report Abuse Neglect or Exploitation

Report Methods

Online Report Form