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:

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.

Untitled Title
Name *
Your answer
Phone *
Your answer
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?
Have you reported the crime(s) to law enforcement? *
If yes, has anyone been arrested, charged, or convicted?
Your answer
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