CASA Central Victoria
03 5441 0430
(Mon to Fri, 9am-5pm)
Sexual Assault Crisis Line
1800 806 292
all other times
CASA Central Victoria
03 5441 0430
(Mon to Fri, 9am-5pm)
Sexual Assault Crisis Line
1800 806 292
all other times

Referral forms

To heal, you need to be heard

 Life can change when you talk to someone who listens and responds with respect and care.

 

Who is eligible for a service at CASACV?

We receive referrals for children and young people under 18yo if they have experienced sexual abuse or assault or have exhibited problematic or harmful sexual behaviour to another person. It is important that children and young people are physically and emotionally safe while they receive counselling.  It is also vital that they feel supported by those around them and there is much evidence that shows how young people recover quicker and achieve better outcomes from their counselling when this is the case.  With permission, we encourage all carers, family members and important people in young people’s lives, to be included in the therapeutic process.

We accept referrals for adults who have experienced sexual abuse or assault, no matter how long ago in the past it may have occurred.  The victim survivor needs to have a memory or partial memory of the abuse and be in a safe and supportive environment.

We do not provide a service for adults who have engaged in abusive and/or violent behaviour in any form.

How to make a referral

Accessing a service from CASACV can occur in a number of ways. We receive referrals from caregivers, agency workers, teachers, doctors, the police and others who might be worried about someone they care about or are working with. If this applies to you, please complete the referral form, most relevant to you.

One of the most common methods of referrals is from the person who has experienced sexual assault. A person can contact CASACV by calling our Intake and Counselling Team on 54410430 and ask to speak with an Intake Counsellor/Advocate. During this process you will be asked a series of questions, to allow us to understand the assistance needed. This process can take up to 30mins. Alternatively, you can complete the self-referral form below and one of our Intake Counsellor/Advocates will call you. Please note that CASACV calls from a private phone number.

The forms on this page allow you to easily refer yourself, or a client for our services.

Please contact CASACV on 5441 0430 if you have any queries regarding the completion of these forms.

Answering questions about experiences of Sexual Assault can be challenging. Please take your time and have a break if needed.

To complete a form at later time please use the “Save Form and Complete Later” link at the bottom to generate a unique link that you can email to yourself to return and then complete.

Please note CASACV delivers services to people living in suburbs within the Loddon Campaspse Region – please check the CASACV Post Code and Suburb Directory below to ensure we service your area.

CASACV Suburb and Postcode Directory

Or go to the CASA Forum website for the CASA that services your area.

https://www.casa.org.au/contact-us/find-your-nearest-casa/

Self referral

Referral (adult)

Referral (children & adolescents)

Referral (DHHS child protection)

Referral - REFOCUS