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Online self-referral

If you have concerns for your immediate safety, or that of someone that you know, please contact the police on 000 or contact the National Sexual Assault, Domestic Family Violence Counselling Service on 1800RESPECT (1800 737 732) for referral to a family violence service in your state or territory.

The National Safer in the Home program can only work with women who are currently experiencing the ramifications of historical or ongoing family violence. For all other support requests, please visit The Salvation Army’s Contact Us page to find available support services near you.

Name: *

Postcode: *

Phone number (if safe):

Email address (if safe):

Has COVID19 impacted on your experience of family violence?: *

Do you have any concerns about technology-facilitated abuse?: *

Preferred language: *

Have you read the eligibility criteria?: Yes No

Do you understand that you are applying for a family violence safety and security package?: Yes No

Current situation (brief): *

Please indicate your self-assessed level of risk: Low Medium High

Preferred day and time to be contacted:

* Required field

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Online self-referral

If you have concerns for your immediate safety, or that of someone that you know, please contact the police on 000 or contact the National Sexual Assault, Domestic Family Violence Counselling Service on 1800RESPECT (1800 737 732) for referral to a family violence service in your state or territory.