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

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 Response Team on 54410430 and request 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 IRT 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.

If you run out of time to complete a form, 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 it.

Self referral

Referral (adult)

Referral (children & adolescents)

Referral (DHHS child protection)

Referral - REFOCUS