Order of Protection Assistance Intake Form

Please complete the form below to seek assistance with completing an Order of Protection petition in Greenville County. If you need emergency shelter, please call our 24/7 line at 1.800.291.2139 (select "1" to speak with someone.)

Before completing this intake, please visit our Orders of Protection Assistance page to determine if you are eligible to apply for an Order of Protection. 
 

Once you complete the form below, we will be in touch within three business days. Please be sure to include a phone number and/or email address where you can be safely reached. If you have not heard from us within three business days of submitting this form, or if you have safety concerns, please contact us at info@safeharborsc.org or at 1.800.291.2139. You can also visit our safety planning page. Thank you!

I have read and understand these intake agreements:
I have read and understand these intake agreements: is required
First Name is required
Last Name is required
Address is required
City is required
State is required
Zip Code is required
Please enter a 10 digit phone number
Please enter a valid email address
Have you previously used Safe Harbor's services?
Have you previously used Safe Harbor's services? is required
Has the person who has been harming you ever participated in Safe Harbor's services?
Has the person who has been harming you ever participated in Safe Harbor's services? is required
Please check one or more boxes that describe your relationship to the person who harmed you.
Please check one or more boxes that describe your relationship to the person who harmed you. is required
Please briefly describe the most recent incident when he/she physically harmed you or threatened to physically harm you. is required
Was there an arrest or police report made due to the incident of abuse?
Was there an arrest or police report made due to the incident of abuse? is required
Is he/she currently in jail?
Is he/she currently in jail? is required
Do you currently have a Family Court case pending for separation, divorce, child custody or other legal matters?
Do you currently have a Family Court case pending for separation, divorce, child custody or other legal matters? is required
Have you ever filed for an Order of Protection in the past?
Have you ever filed for an Order of Protection in the past? is required

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