Safe Connections Phone Request

Safe Connections Contact Form

Request a Safe Connections Phone

Use this form to contact WESNET by email.

"*" indicates required fields

Name*

First Last

Email*

Enter Email Confirm Email

Is it safe for Wesnet to contact you at the email address provided? (if unsure, select 'NO' and call 1800 937 638 from a payphone or trusted person’s device)

YES

Is it safe for Wesnet to contact you by phone? (if unsure, select 'NO' and call 1800 937 638 from a payphone or trusted person’s device)

YES

Phone

Are you a woman affected by Domestic and Family Violence?*

Who referred you to our program?*

Are you currently working with a Domestic and Family Violence service - if so, which one?*

Please enter your suburb and state to assist us with referring you to a Safe Connections agency in your area.

Suburb*

State*

Are you able to safely travel to a service to receive a phone?*

Yes

Please provide further detail as to the situation with your current phone*

Safe Connections Contact Form

Request a Safe Connections Phone

Please enter your suburb and state to assist us with referring you to a Safe Connections agency in your area.

How the program works