Report Concern Form

Report Concern

Report Concern Form

Report Concern

Thank you for taking the step to report concerns about potential child abuse. Whether you are experiencing abuse or have noticed signs of it, this form is here to help you share important information confidentially.

Please be assured that CPOC will treat your report with the highest level of confidentiality. You may submit this form anonymously if you wish. If you choose not to provide your name, you may still include an email address so we can follow up with you if needed.

First Name

Last Name

Initiated name (if not relevant, state so)

Gender

Country of residence

Email or phone number