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Attorney Referral Request
Please complete the form below if you are seeking an attorney referral. Once you have completed the form, your request will be processed - you DO NOT need to e-mail or leave a message on the Attorney Referral Service voicemail. Also, if you have already e-mailed or called the Attorney Referral Service, you do not need to complete this form. If you are not seeking an attorney, but are a crime victim looking for other resources, please call our helpline at 1-855-4VICTIM or visit the Victim Connect website here to chat: http://victimconnect.org/.

Typically, we can provide referrals in cases of sexual assault or severe physical injury. However, cases are very fact-specific, and whether we can provide a referral will depend on the circumstances of the case.

Name
Your answer
Phone
Your answer
Email
Your answer
What was the crime(s) committed?
Your answer
When did the crime(s) occur?
Your answer
Where did the crime(s) occur?
Your answer
Do you know the perpetrator?
If yes, what is your relationship?
Your answer
Have you reported the crime(s) to law enforcement?
If yes, has anyone been arrested, charged, or convicted?
Your answer
Submit
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