Choices DVIP
Opportunity for Change
9828 E. Burnside, Suite #210
Portland, OR 97216
(503) 239-7597
(503) 232-4446 FAX
endviolence@choicesdvip.com
ABOUT US
|
REFERRAL FOR DV, DUI & A&D
|
INFORMATION
|
CONTACT US
REFERRAL FORM
From:
Email Address:
Office:
Telephone:
Fax:
Offender Name:
Address:
Telephone:
Employer:
Charges:
DOMESTIC VIOLENCE PROGRAM
Culturally Specific Programs:
Russian
Spanish
Men's Domestic Violence Program:
52 weeks only
Women's Domestic Violence Program:
36 weeks
52 weeks
Men's Spanish Domestic Violence Program:
52 weeks only
Parenting Group:
yes
Victim's Group for Victim:
yes
Is Offender allowed contact with Victim?
yes
no
DUI / ALCOHOL & DRUG PROGRAMS
Culturally Specific Programs:
Russian
Spanish
Alcohol and Drug Assessment Only:
yes
Women's Program:
yes
DUI Specific Program:
yes
DHS OR OTHER ASSESSMENTS
DVI:
yes
ODARA:
yes
Cambell Risk Assessment:
yes
Full Written Report Needed ($65.00):
yes
Will PO/DHS be paying for any services?
If so, what?
Victim Name:
Relationship:
Victim Telephone:
IS IT SAFE TO CONTACT VICTIM AT THIS NUMBER?
yes
no
DOES VICTIM WANT CHOICES TO CONTACT HIM/HER?
yes
no
