Referral Form

    Is this a self referral or agency referral?

    Self ReferralAgency Referral

    Please be aware that due to current high demand there is a longer than usual wait time for an initial appointment with our Victim Support Unit. We will contact your referred client to book an appointment at the first available opportunity.

    Please be aware that due to current high demand there is a longer than usual wait time for an initial appointment with our Victim Support Unit. We will contact you to book an appointment at the first available opportunity.

    For emergencies and urgent needs please contact:
    000
    Lifeline 13 11 14
    1800RESPECT (1800 737 732)
    13YARN (13 92 76)

    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 consentArsonBreak and EnterCriminal Road AccidentFamily ViolenceFraudHome InvasionHomicideGlassingPhysical AssaultSexual Violence - recentSexual Violence - historicalStabbingShootingTheft/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.