Agency Referral

    Please be aware that due to current high demand there is a three to four week wait time for appointments. We will contact your referred client to book an appointment at the first available opportunity.

    Did the crime occur within NSW?

    Please note at this point in time we are only able to support victims of crime which occurred within NSW.

    Victim-Survivor Details

    Name

    Preferred Name

    Phone Number

    Email

    Date of Birth

    Address

    Gender

    Aboriginal or Torres Strait Islander?

    Culturally and linguistically diverse (CALD) ?

    Is there a disability?

    Agency Referral Details:

    Referrer's Name

    Referrer's Organisation

    Referrer's Phone Number

    Referrer's Email

    Victims Services CounsellingVictims Services Financial AssistanceAssistance with Police statementCourt preparation and supportVictim Impact StatementFamily Court matterState Parole Authority SubmissionCoroners Court matterMental Health Review TribunalOther

    Abduction/detained without consentDestroy Property by Fire (Arson)Break and EnterSerious Road CrimeDomestic and Family ViolenceFraudHome InvasionHomicideGlassingPhysical AssaultSexual ViolenceStabbingShootingTheft/RobberyThreats, stalking, intimidation,Technology facilitated abuseOther

    Supporting documentation

    If you have any supporting documentation to provide in relation to your referral please email them direct to admin@vocal.org.au

    Send copy of referral submission to this email address (required)

    We will confirm with you via email upon acceptance of the referral.