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Referral Form

Domestic Violence in Regional WA

You can refer someone for DVassist to contact them directly

If you are a family and domestic violence service provider or professional, you can refer clients into our multi-session and case management services by completing our referral form below.

DVassist will only reach out to a client directly if they have provided consent for DVassist to contact them.  When completing the referral form please include all relevant information regarding the best and safest times for DVassist to contact the referred individual.

Please, explain to the person you are referring, that we will be calling from a private number and will not leave a message unless it is stated in the referral form that it is safe to do so.  The person being referred also has the option of calling 1800 080 083 directly if they prefer.

The form below will be submitted directly to the DVassist Senior Practitioner.  A DVassist staff member will contact you within one week to discuss your referral.

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