This form is designed to be used by women from migrant and refugee communities experiencing family violence.

If you would prefer to have a phone conversation please call us on 1800 755 988.

inTouch is not a crisis service. If you feel unsafe or 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.

    Your details
















    Your experience of family violence








    COVID-19 Risk Assessment


    Submitting this form will send the information you have provided to inTouch. An intake worker will contact you within 2 business days.