Incident Report

Americans Against Fraudulent Self-Help

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Fraudulent Self-Help Incident Report Form!

Use the form below to report suspected fraud. The information you provide will be added to the existing AAFS database & listed on this website excluding personal data. If the problem does NOT deal with mental health or interpersonal relationships, please contact your state attorney general’s office or the Federal Trade Commission at www.ftc.gov.

Privacy Policy: AAFS is committed to protecting your privacy & will never pass on or sell to a 3rd party any information you may provide us.

	Your Information
	Name or Personal Identifier: (i.e birth date)
	Email address:
	Zip Code:	(5 digits - for statistical purposes only)
	State:
	Self-Help Provider's Information
	Person or Company:
	Self-help product:
	Type of self-help: (personal growth, relationship, financial, etc.
	Form of self-help: (book, CD/DVD, seminar, coaching
	Cost: (how much did you pay?)
	Self-help provider's website:
	Incident Details (Please provide responses to the following questions. Be brief as as possible, you are limited to 400 characters.)
	1. Why do you think there is fraud? 2. What, if any, action have you taken to reconcile your concerns? 3. Do you have concrete proof of actual physical, emotional or psychological harm? 4. Why are your reporting this? 5. What resolution do you seek?	Enter comments here!