DwellWell

Inquiry Maint

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Field	Field Value
Inquiry Number
Inquiry Date *	[10-24-2026]
Woman First Name
Woman Last Name
City
Current Living Situation
Phone Number
Work
Work Description
Referral Phone
Program Type
Do you have a child with you?
Children 3 and up, call Theresa Shelter 563-690-0086
Due Date	[10-24-2026] [Clear]
Relationship Status
Protective Services Involved
Drug/Alcohol/Marijuana
Drug of Choice
Last use
Brain Health Diagnosis
What are your prescribed medications
Criminal History
Fleeing Domestic Violence
Please call DVS 563-690-0086
Protective Order
Car
Tour Date
Declined Notes
Referred To
Final Notes
Okay to Text
Okay to leave Message
Okay to Identify Ourselves
Are you safe, if not, call 911
Active *

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