Self Referral

Are you in unsafe situation?

If you feel unsafe, threatened or fearful for yourself, a child or family member, please call 000
If you are in a crisis, call Safe Steps, Victoria's 24/7 family violence response line on 1800 015 188

Do you only require legal service?

The inTouch Women's Legal Centre provides legal assistance to clients as part of an integrative practice model, along with other services of inTouch.
In case you only require legal advice, we highly recommend you to look for another legal services.

How inTouch Women’s Legal Centre Work

To ensure we can provide the most appropriate and effective support for your specific situation, our standard procedure requires all clients to first engage with our intake process. This initial step allows us to conduct a thorough assessment of your needs and circumstances.

Following the completion of the intake, if legal support is identified as the appropriate pathway, a request will then be made to the Women's Legal Centre.

Do

Don't

How to get support from inTouch Women’s Legal Centre

Do you only require legal service?(Required)

Yes

No

Our services are designed to support those who:

Are women or gender non-binary clients agreeable to support from a women’s service

Are aged 18 years and older

Reside in Victoria

Are experiencing current or ongoing impact of family violence

Require an in-language and/or culturally tailored family violence service response

Require support across multiple areas and/or have complex needs

Unfortunately, we have not been able to match any of our services to your needs

Based on your answers it appears inTouch is unable to assist you with your specific matter at this time.

We know your issue is important and that finding assistance can be difficult, so we recommend exploring the following options:

We recommend that you contact the [……………… ], or [………..]

On our website, we’ve collected some information on other services you may be able to access.

Self Referral Form

Your Full Name(Required)

First Last

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile Phone(Required)

Date of birth(Required)

Year of arrival in Australia

Visa Status

Gender Identity(Required)

Cultural Identity(Required)

Do you, or anyone else in your household indentify as Aboriginal or Torres Strait Islander?”(Required)

Dialect(s) / Language(s) spoken *(Required)

Do you require an interpreter?(Required)

Do you require an AUSLAN interpreter (sign language)?

When is it safe for us to call you? *Please note – all calls from inTouch will appear as a private/unknown phone number.(Required)

Is it safe for us to leave a message on your phone? (select all that apply)

It is safe to leave a voicemail message

It is safe to send a text message

It is not safe to send a text message or leave a voicemail

Your Experience of Family Violence

Please detail the most recent incident and when it occured, as well as any past history of family violence you'd like us to know about.

Do you have children in your care? If so how many and what are their name(s) and date(s) of birth?

What are your current circumstances? (For example- Do you live with the person who is choosing to use violence? Have the police or courts been involved?)

Are you currently connected with any other services? (For example: The Orange Door, other family violence services, a lawyer, child protection, counsellors, housing providers?)

Name of the person choosing to use violence

Your relationship to this person

Gender of the person choosing to use violence

What assistance or areas of support would you like from inTouch?(Required)

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Comments

This field is for validation purposes and should be left unchanged.

Self Referral

Are you in unsafe situation?

Do you only require legal service?

How inTouch Women’s Legal Centre Work

Do

Don't

How to get support from inTouch Women’s Legal Centre

Unfortunately, we have not been able to match any of our services to your needs

Self Referral Form

Your Experience of Family Violence

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Who we are

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