Foothills Domestic Violence Peer Support Group

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Foothills Domestic Violence Peer Support Group - Connection form

Foothills Domestic Violence Peer Support Group can offer peer support in various ways. This form will help us understand the best ways we can support you.

We will keep your information private at all times and will only contact you at your request and on your terms.

Our group can offer phone, email and face-to-face connection. We also use password protected Zoom meetings for those unwell or unable to attend meetings in person. We can also organise home-cooked meals, groceries and fresh produce delivered to you free through Community Casseroles and free online art groups.

This group is a support space for mothers who have experienced domestic violence who reside in the Dandenong Ranges and surrounds with support for as long as you need it. We are a peer-run group, sharing connection and understanding through knowing what it's like and having a lived experience of domestic and family violence. Our peer support women have training in Intentional Peer Support.

You are not alone.

Name *

Do you have another name that you use on Facebook, this may be a pseudonym

This information will help us add you to our secret Facebook group for community connection and support

What is your preferred method of contact? *

How would you like us to contact you after you fill out this form? We will ask you for your contact details in the next questions and you can provide email or phone as you feel comfortable. If you would prefer a different method of contact to these, please let us know here.

Phone

Other:

Phone number:

Email address:

We will email you links to the zoom group. Please let us know if you are worried that your email isn't secure (eg, someone else might know your password or have access to your account) *Please remember to check your spam folder as we will send you a welcome email within a week.

Do you have any instructions for calling you?

Please include any instructions (e.g. please call between certain hours or on certain days. Please note we are unable to text prior to calling but we can email)

Yes - please specify under "other"

Other:

Is it ok to leave a message on your phone? * *

Yes

What suburb are you in?

How can we best support you? *

(tick as many as applicable)

I would like to connect with a peer via telephone

I would like to join the private Facebook support group

I would like to connect one-on-one with a peer support worker. (Meeting would be in a public place.)

I would like to connect one-on-one via Zoom. This is secure, password protected platform.

I would like support with free meals and groceries via Community Casseroles

I would like to participate in a weekly peer support group (also available via secure video conferencing - Zoom)

I would like to participate in the art group when they are held.

I need support contacting a specialist domestic violence service (such as EDVOS, Safe Steps, 1800 Respect)

Required

How did you find out about Foothills Domestic Violence Peer Support Group?

Social Media (Facebook, Instagram etc)

Personal referred or recommendation

Flyer

Community Casseroles

Foothills Community Care Website

Other:

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Is there any other information you'd like a peer support woman to know before meeting you:

Are there any barriers for you to connecting with our Peer Support Group that we can support you with?

We understand that reaching out to us may be challenging for you for practical and emotional reasons. Are there any ways we can better accomodate you? If you have concerns about the security of your phone or computer we can offer suggestions for securing your device. Please also let us know if you need practical accomodations due to disability or for other reasons.Your answer

Any other comments or questions?

Submit

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This form was created inside of Foothills Community Care. Report Abuse

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