PartnerSPEAK 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.
Please note, PartnerSPEAK is only able to offer phone, email and face-to-face support for residents of Australia. If you are outside Australia please seek support from our online forum
You are very welcome to connect with us through our Peer Support Peerline:
1300 590 589
Our lines are open:
Tuesday 10am - 1pm AEST
Wednesday 6pm - 9pm AEST
Thursday 3pm - 7pm AEST
You can also connect with a peer support worker using live online chat during these times through the forum (look for the purple speech bubble on the bottom right
If you can't call during these hours you can leave a message or you can fill in your information below and we will get back to you.
If you are a doctor, psychologist or student seeking more information about PartnerSPEAK please see the section on the website 'Information for professionals'
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to save your progress.
Or name you would like us to use, this can be a pseudonym
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.
Do you have any instructions for calling you
Please include any instructions (e.g. please call between certain hours or on certain days)
Is it ok to leave a message on your phone?
What part of Australia are you in?
How can we best support you?
(tick as many as applicable)
I would like to connect with a peer support worker via telephone
I would like to connect with a peer support worker via online technology (like Instant Messenger)
I would like to connect face-to-face via technology (e.g. by Zoom. This is available Australia wide)
I would like to participate in a PartnerSPEAK peer support group (currently through secure video conferencing online)
I would like to attend a PartnerSPEAK information and community gathering event (currently through secure video conferencing online)
I would like to know more about accessing the online forum
I would like to be emailed about upcoming workshops
I would like some support attending a police station, court or family violence service
How did you find out about PartnerSPEAK?
Word of mouth/from someone you knew
Saw PartnerSPEAK in the media
Attended a PartnerSPEAK event/workshop/talk
Referred by Berry St
Referred by WIRE (Women's Information Referral and Exchange)
Referred by a Centre Against Sexual Assault (CASA)
Referred by a Domestic or Family Violence agency
Referred by another agency/organisation
Is there any other information you'd like a peer support worker to know before meeting you:
Are there any barriers for you to connecting with PartnerSPEAK that we can support you with?
We understand that reaching out to PartnerSPEAK 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.
Any other comments or questions
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This form was created inside of PartnerSPEAK.