Elder Abuse Complaints (Internal)

For Office of Attorney General staff: use this internal form to log scam complaints received by phone, mail, or in person. Record the reporter’s information and the details of the scam so the team can review and follow up.

"*" indicates required fields

Consumer Information

Veteran Status
Senior Status
Name*
Address
Email

Victim's Information

Name
Address

Who is the complaint against?

Address
This Complaint is regarding

Complaint Information

Try to be brief, but be sure to tell WHAT happened, WHEN it happened and WHERE it happened. Be specific about any oral statements the business made to you, ESPECIALLY those that influenced you to deal with the company. Describe events in the order in which they happened, referring to all contracts, letters, receipts, cancelled checks, advertisements or other papers that will support your claim.
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 256 MB, Max. files: 25.
    PLEASE READ CAREFULLY THE ATTORNEY GENERAL CANNOT ACT AS YOUR PRIVATE ATTORNEY The primary function of the Office of Attorney General is to represent the public at large. The Senior Protection Unit may mediate your complaint if it falls within the jurisdiction of this office. Be advised that the information you provide may be shared with the party you have complained about and may be shared with or referred to other law enforcement or regulatory agencies. Your complaint will be kept on file with our office and the information may be used to establish violations of Pennsylvania law. By submitting below:
    1. I authorize the Senior Protection Unit to provide a copy of this complaint to any person or entity about which I am complaining; and to any person or provider possessing medical and insurance records or information related to this complaint.
    2. I authorize the Senior Protection Unit to transfer my complaint to another federal, state, local, or other agency which may have jurisdiction over this matter. This authorization extends to any and all attachments which may be part of my case file, including any medical records the Office may obtain pursuant to a medical release. Additional information may be requested.
    I certify that the information provided in this complaint form, including my identity and any factual statements or allegations, are true and correct to the best of my knowledge, information, and belief.