Missing Person Case Submission Form

To help us create an accurate case page for the missing person, please provide the following information. While certain information is required (denoted with *), other pieces of information are optional. If certain questions make you uncomfortable, you are free to skip these sections. If you have any questions or concerns, please feel free to contact us at any time. Thank you!

PART 1: BASIC INFORMATION ABOUT THE MISSING PERSON
Last Name*	Given Name(s) *
Alias(es)/Nickname(s) (if any)	Name usually used/preferred
Date of Birth* (format: dd/mm/yyyy) (For internal use only)
City/Town where born	Province/ Territory where born	Country of birth
Address of residence (at time of disappearance)*
City or Town (at time of disappearance) *	Province or Territory*	Postal Code

PART 2: LAST CONTACT WITH THE MISSING PERSON
Date of last seen (format: dd/mm/yyyy) *	Age at disappearance *
Location/address where last seen*
City or Town*	Province or Territory*
Description of place last seen (e.g. private residence, public park, business, work place, amusement park, etc.)

Clothing last seen wearing
Article/Item Choose an item.	Description (Colour, Style, Size, Brand, etc.)
Article/Item Choose an item.	Description (Colour, Style, Size, Brand, etc.)
Article/Item Choose an item.	Description (Colour, Style, Size, Brand, etc.)
Article/Item Choose an item.	Description (Colour, Style, Size, Brand, etc.)

Personal items taken by missing person
Personal Item Choose an item.	Description
Personal Item Choose an item.	Description

PART 3: PHYSICAL DESCRIPTION OF MISSING PERSON
Height	Weight
Sex* Choose an item.	Race* Choose an item.
Additional race information (e.g. if more than one race category applies)

Hair Information
Hair Colour Choose an item.	Length Choose an item.	If hair was dyed, what colour was it dyed?
Additional Identifiers: (e.g. second prominent colour, whether 'light' or 'dark' intensity, texture of hair, etc.)
Facial hair? (type, style, length, etc.)

Eye and Vision Information
Eye Colour Choose an item.	Does the missing person wear prescription glasses?
Any other distinctive eye features?

Dental Information
Does the missing person wear dentures?
Wore braces at the time of going missing?
Additional dental information (e.g. whether wisdom teeth present, visible spaces between teeth, gold teeth, specific location of treated or missing teeth, etc.)

Medical Information
Previous surgeries?	Details (e.g. type of surgery, location, etc.)
Previous injuries/broken bones	Details (e.g. type of injury, body location, etc.)
Mental health concerns (if any)	Details
Addictions (if any)	Details
Additional medical details (e.g. requires daily medication, receiving treatment on outpatient basis, etc.)
Gender specific Information – for internal records only
Female missing Has the missing person given birth?
Missing Male Is the missing male circumcised?

Identifying or Unique Features – e.g. scars, moles, beauty marks, deformities, piercings, etc.
Feature (e.g. scars/moles, etc) Choose an item.	Body location and description
Feature (e.g. scars/moles, etc) Choose an item.	Body location and description
Feature (e.g. scars/moles, etc) Choose an item.	Body location and description
Feature (e.g. scars/moles, etc) Choose an item.	Body location and description

Tattoo Information
Body location	Description
Body location	Description
Body location	Description

Additional descriptors (e.g. mannerisms, speech patterns, habits, smoking habits, gait, etc.). Other details to include are past military service, languages (spoken, written, understood), hobbies, clubs, sports activities or volunteer work.

Circumstances surrounding the missing person's disappearance
Please provide details surrounding the missing person's disappearance in the space below. Additional information can be submitted using any word processing package or email.

PART 4: POLICE CONTACT INFORMATION
Agency name
Name of Lead Detective/Officer	Case File Number (if available)
Phone Number	Email address

PART 5: YOUR CONTACT INFORMATION – for internal use only
Last Name*	Given Name(s) *
Current Address*
City or Town *	Province or Territory*	Postal Code*
Telephone Number* Home: ( ) - Work: ( ) - Mobile: ( ) -
Email Address*	Please re-type email address

PART 6: PHOTOGRAPHS
Please provide a recent photo of the missing person. Photos showing the person’s face and shoulders as well as those showing how s/he usually looks are good to include. Providing photos scanned at a high dpi will help us to resize photos prior to uploading to the website. If you have photos of distinctive features (e.g. tattoos), these can be added as well. Electronic copies of photos should be sent to Photos@missingadults.ca

By completing and submitting this form, you are agreeing to post this information to Ontario's Missing Adults public website and Facebook group, unless otherwise indicated on the form.

You are also agreeing that the information provided above is accurate and true to the best of your knowledge. Further, you are provding permission to have a representative from Ontario's Missing Adults contact you in the event that further information or clairifcation is needed.