HPD Referral Form

HPD Referral Form

Thank you for your referral. Please inform the victim that when a staff member reaches out to them from DVAC, it will appear as an unknown call. If this is a crisis situation or the victim needs immediate assistance, please have them access our 24/7 text line at 605-956-5680 or chat with us at www.domesticviolenceactioncenter.org

Is the client interested in DVAC services?
URGENT (48hr no contact order issues?)
Was an arrest made?

Victim's information

Suspect's information

Suspect's relationship to victim?

Upload supporting documents to genias@stoptheviolence.org - please include the Report Number in the subject line.