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Miami-Dade County Clerk of the Courts


Domestic Violence Intake Questionnaire

Note: a printer is required after filling out this questionaire as you will need to take it with you to the Intake office.
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The following information is requested about YOU (the Petitioner):
Birth Date*
Place of Birth
Zip Code
Phone Number*
Alternate Phone Number
Ethnic Origin
Name and Relation of Contact Person
Contact Person Telephone Number
Employment Information:
Employer's Address
Employer's City
Employer's State
Employer's Zip Code
Employer's Phone Number
Items marked with an asterisk (*) are required.

Please be advised:

The Miami-Dade Clerk’s Office makes every effort to ensure the accuracy of the following information; however it makes no warranties or representations whatsoever regarding the completeness, accuracy, or timeliness of such information and data. Information on this website has been posted with the intent that it be readily available for personal and public non-commercial (educational) use and to provide the public with direct online access to information in the Miami-Dade Clerk’s Office information systems. Other than making limited copies of this website's content, you may not reproduce, retransmit, redistribute, upload or post any part of this website, including the contents thereof, in any form or by any means, or store it in any information storage and retrieval system, without prior written permission from the Miami-Dade Clerk’s Office. This website does not provide legal advice of any kind. If you require legal advice, please consult a qualified attorney of your choosing.

Service through the Clerk’s electronic access is not the official record of the Clerk. In order to assure the accuracy of the data or information, the Clerk’s Office should be consulted regarding the Official Court Record.

If you are interested in obtaining permission to reproduce, retransmit or store any part of this website beyond that which you may use for personal use, as defined above, visit our Web API Services. You can review the complete Miami-Dade County Disclaimer.