Victims Legal Services Referral

We ask you to fill out this form so we can work out if we can support you with your legal problem and if you are eligible for our services.

The information you provide here will be confidentially and safely saved in our system. Our administrative staff, paralegals and lawyers will use this information to contact you, make an appointment with a lawyer and work out how we can assist you.

We aim to get in touch with you within 5 business days of you submitting this form.

Enquiry date

Which Victims Legal Service Provider do you work for, if any?

If you do not work for a Victims Legal Service provider, which organisation do you work for?

What does the client need legal help with?

Please hold down the 'ctrl' button to select more than one option.

The client's first name

The client's last name

The client's date of birth

The residential street address for the client

The suburb the client lives in

The state/territory the client lives in

The postcode for the suburb the client lives in

Client's phone number

The client's email address

Does the client consent to you sharing their details/information to us to allow usWomen's Legal Service Victoria to

Please hold down the 'ctrl' button to select more than one option - full consent will require both options to be selected

Does this matter require urgent legal assistance?

If yes, why?

The first name of the other person who is involved in the legal issue

The last name of the other person who is involved in the legal issue

The date of birth of the other person involved in the legal issue

Please provide the first name, last name, date of birth and information about your relationship to the person, for any other people involved in your legal issue. If there is noone else involved in your legal issue, please say "not applicable". PLEASE LIST ALL CHILDREN HERE.

This may include children, other family members or people who are not related to your client

Location of event/incident

Which of these factors are relevant to the client

Please hold down the 'ctrl' button to select more than one option

What is the client's main language spoken?

If the language your client needs is not in the list above, please provide the language details here

If the client requires an interpreter, please select the language/dialect the client needs the interpreter for

How would the client like us to communicate with them?

Please hold down the 'ctrl' button to select more than one option

When is it safe to contact the client?

Please let us know of any accessibility requirements for the client

How did the client hear about the Victims Legal Service?

What details can you provide about the matter, including any Court or filing dates