Self Referral

    Please be aware that due to current high demand there is a three to four week wait time for appointments. 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)
    QLife 1800 184 527 Between 3pm-Midnight 7 days

    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?

    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.