Refer a person for victim assistance

  1. Eligibility
    1. Has the victim given you consent to contact us?*
    1. Did the act of violence take place in Queensland? *If you selected 'Yes' above
    1. Tell us what the act(s) of violence were. *If you selected 'Yes' above
  2. Act of violence details
  3. dd/mm/yyyy
  5. Type of injury *
  6. Other injury *If you selected 'Other' above
  8. Was the event reported to?
  9. Police
  10. Doctor
  11. DFV worker
  12. Psychologist or counsellor
  13. Assistance required
    1. What kind of assistance does the victim need? *Select all that apply.
  14. What type of assistance is required? *If you selected 'Other' above
  15. Court information If you selected 'Court information and support' or 'Help with victim impact statement' above
  16. Are there any additional support requirements? For example, if they have a disability that affects their ability to communicate.
  17. Victim/client details
  18. Address
  19. Safe and preferred contact method*Select all that apply.
  21. Cultural background Optional
  22. Does your client want an interpreter when talking to VAQ? *
  23. Specify language *If you selected 'Yes' above
  24. Is the client under 18? *
  25. Who can we contact to about the referral? Parent/guardian details are preferred. If these are not available you must provide your contact details. *
  26. Parent/guardian details
    27. Your details
  30. *
  31. *
  32. *
  33. *
    34. Privacy statement

    The Department of Youth Justice and Victim Support collects your personal information from you, including information about you and your client’s name, address, telephone number and email address. We also collect information about your client’s date of birth, medical information, court information and the act of violence involving them. We collect this information so we can give your client information about services to support them. The Victims of Crime Assistance Act 2009 allows or authorises us to collect this personal information. We will only use the personal information for this purpose. It will otherwise not be used or disclosed without consent unless authorised or required by law. Your and your client’s personal information will be handled according to the Information Privacy Act 2009 and Human Rights Act 2019.

    If you provide an email address supported by servers outside Australia, and you have asked us to communicate with you using that email address, your and your client’s personal information will be transferred overseas. If you do not wish to communicate with us by email, phone 1300 546 587 (business hours) or write to Victim Assist Queensland, GPO Box 1452, Brisbane, Queensland, 4001.

Last updated:
15 July 2026