This form is for a member of the public to request support or advice from Victim Care Merseyside. It should not be used to report a crime to the police.

A member of the Victim Care Merseyside team will be in touch within 2 working days to respond to your query.

Your Name

Date of birth

Address

Are you completing this form on behalf of someone else?

Please indicate if you are completing this form on behalf of someone else (Required)

If you have a Crime Reference Number, please enter it below

This number will be on any letters you have received relating to a reported crime

Preferred contact method

Please indicate your preferred contact method (Required)
Only choose contact methods that are safe for you - e.g., can we leave a voicemail if we call you, or should we send you a text message or email instead? Please enter at least one contact method.

Preferred time for us to contact you

When we contact you, would a language line be useful?

Please indicate if you require a language line (Required)

How can we help?