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Public Health Unit
GV Health Foundation
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Contact
Emergency

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Emergency

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GVCASA Professional Referral

Step 1 of 4

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Referral date

Name of referrer

Organisation

Phone number

Email

Client Name(Required)

Please note, a name (can be an alias name) and a number is required so GVCASA can contact the client to organise an intake and assessment.

Date of birth

Gender

Does the client identify as Aboriginal/Torres Strait Islander?

Country of birth

Language spoken at home

Phone number(Required)

GVCASA will contact the client through a private number, would they prefer to be contacted via phone call or a text message?

Can a message be left on the phone?

Can a text message be left on the phone?

Address

Does the client have a diagnosis/disability?

Any additional information?

Is the client the direct victim survivor of the sexual assault?(Required)

Recency of sexual assault (select all that apply)

Current

Historical

Childhood Sexual Assault

When did the sexual assault occur?(Required)

Recently – within the last month

Not as recently – within the last 6 months

A little while ago – between 6 months to 2 years ago

In the past – over 2 years ago

Perpetrator status(Required)

Relative

Known person

Unknown person

Multiple perpetrators

Does the victim survivor currently have contact with the perpetrator of the sexual assault?(Required)

Reason for referral(Required)

Has the client experienced family violence (current or past experience)(Required)

If the client has disclosed family violence, please add any relevant risk assessments or safety plans (if applicable) in the file upload option on the next page.

Mental Health History

Drug & Alcohol History

Current Supports

Has the sexual assault been reported to police/has the client been interviewed by SOCIT (police)?

Current safety/risk factors identified

Other agencies involved with the client

Additional Comments

Please confirm that the client is aware and has given permission that this referral be made on their behalf(Required)

Other relevant information

Upload additional supporting documents

Max. file size: 50 MB.

Please note, after the referral is received GVCASA will contact the client. A maximum number of 3 attempts will be made and if we cannot get in contact with the client after this, the referral will be closed.

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CONTACT

Emergency: 000

Phone: 1800 112 343

Sexual Assault Crisis Line – free call 1800 806 292

SACL is staffed by counsellors specifically trained in supporting victim survivors of sexual assault.

Nurse on call: 1300 60 60 24
for non life threatening injury/illness

Email: gvcasa@gvhealth.org.au

RESOURCES

Victorian Centres Against Sexual Assault Standards of Practice

Contact Details

Emergency: 000
Phone: 03 5832 2322
Nurse on call: 1300 60 60 24

for non life threatening injury/illness

Location and maps

Graham Street
Shepparton VIC 3630
Australia

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Contact Details

Emergency: 000
Phone: 03 5832 2322
Nurse on call: 1300 60 60 24

Location and Maps

Graham Street
Shepparton VIC 3630
Australia

View GV Health maps