AZ APS Form

Verification


To improve performance and to prevent excessive high-volume use, we have implemented randomly generated verification images that must be selected before clicking the "Continue" button. For questions or technical issues or to discuss options for high-volume access, please contact Adult Protective Services Central Intake Unit (1-877-SOS-ADULT/1-877-767-2385).

Please select the checkbox I'm not a robot and then select all matching images before clicking Continue button.

Trouble?
If you are having problems continuing to the form, try selecting the checkbox and ensure you select the correct images until the checkbox is auto-selected.

age is not valid

date of birth is not valid

validating address...

address could not be validated, this will not prevent submitting the form

address could not be validated, this will not prevent submitting the form

address could not be validated, this will not prevent submitting the form

Reporting Arizona Adult Abuse, Neglect/Self-Neglect, and Exploitation

If you prefer to speak with an APS Representative, please call the Central Intake Unit toll-free telephone number at (877) 767-2385 which is staffed Monday through Friday from 7:00 a.m. to 7:00 p.m., and Saturday, Sunday, and state service holidays from 10:00 a.m. to 6:00 p.m. The online submission service is available 24 hours a day, 7 days a week, including holidays.

Online Submission Form

Some fields below are required (*). Please remember that the more information you provide the better 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.

Important: Progress on this form cannot be saved and must completed in one session.