Professional referral form

This form is for professionals concerned for an older person who is, or maybe experiencing elder abuse. You will be responded to within two (2) working days.  

If the person you are calling about is in immediate danger, please contact 000. We are not a crisis response or elder abuse reporting service.

By submitting this form, you consent for Seniors Rights Victoria to contact you on your preferred contact method, and acknowledge that you may also be referred to COTA Victoria’s COTA WISE information service for assistance and information.

Your information will be collected and stored in accordance with our privacy policy: https://seniorsrights.org.au/privacy-policy/

Professional referral form

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