This form is for police or partners to refer a case to the Victim Care Merseyside team.

It should not be used by members of the public, or to report a crime.

Name of officer in the case

Officers Email

Name of victim

Date of birth


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

Preferred contact method for victim

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.

When we contact the victim, would a language line be useful?

Please indicate if you require a language line (Required)

Notes to assist Victim Care Merseyside