Request information from Victim Assist

We help victims of crime to get back to normal after experiencing violent crime or domestic and family violence in Queensland.

Our information and referral service is available to help you:

• find a free counselling service
• apply for financial assistance
• understand how to write a victim impact statement
• understand victims' rights
• find court support.

It takes about 5 minutes to complete this form.

1. Your details

   1. Name

      1. First name *
      2. Last name *
   2. Date of birth * Example: dd/mm/yyyy
   3. Postcode *
   4. How would you like us to contact you? *

      Safe contact method

      We need a safe way to contact you during business hours, so provide the safest email address, postal address, mobile phone number or landline number we can contact you on.

      If you provide a mobile number, we may use it to call you or to send a text message.

      • Email
      • Post
      • Phone (mobile preferred)
   5. Email * (If you chose 'Email' above)
   6. Postal address (If you chose 'Post' above)

      1. Address line 1 *
      2. Address line 2
      3. Address line 3
      4. 1. Town, city or suburb *
         2. State *
         3. Postcode *
      5. Country *
   7. Phone (mobile preferred) * (If you chose 'Phone' above)
2. Details of the act of violence

   1. Did the violent crime or domestic and family violence occur in Queensland? *

      • Yes
      • No
   2. How were you involved in the violent crimes or domestic and family violence? * Select the category that best describes your situation

      • I am the person who was injured
      • I am the parent of the person under 18 who was injured
      • I witnessed (saw or heard) the incident(s)
      • I am a close family member or dependant of person that has died as a result of the incident(s)
   3. What happened? * Select one

      • A physical assault (e.g. being hit, pushed, punched, restrained or choked)
      • A sexual offence
      • Threatening with a weapon
      • Stalking / kidnapping / deprivation of liberty
      • Violence involving a motor vehicle (e.g. dangerous operation of a motor vehicle causing death or grievous bodily harm)
      • Domestic and family violence committed by an intimate partner, family member, or informal carer
      • An attempted murder or manslaughter
      • A murder or manslaughter of a close family member
      • Other
   4. Describe the act of violence * (If you chose 'Other' above)
   5. When did the violent crime occur? * Select one

      • As a single event
      • Multiple events over a period of time
   6. When did the act of violence occur? * (If you chose 'As a single event' above)

      1. Example: mm/yyyy
   7. 1. The violence began * (If you chose 'Multiple events over a period of time' above)
         1. Example: mm/yyyy
      2. The violence ended * (If you chose 'Multiple events over a period of time' above)

         1. If the violence is still happening, put the current month and year.Example: mm/yyyy
   8. What information do you need? * Select all that apply

      I want to know...

      • about free counselling services
      • how to get financial assistance
      • how to write a victim impact statement
      • about court support services
      • more victims' rights
      • something else
   9. Please specify * (If you chose 'something else' above)

Privacy statement

The Department of Justice and Attorney-General (DJAG) is collecting your personal information, including your name, telephone number, email address and information about the act of violence that happened to you, in order to give you information about services to support you. The Victims of Crime Assistance Act 2009 allows or authorises DJAG to collect this personal information. We will only use your personal information for this purpose. It will otherwise not be used or disclosed without your consent unless authorised or required by law. Your 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 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 149, Brisbane, Queensland, 4001.