Request An Appointment

Please submit a request online below or by phone at 612-871-5111 and our team will explore your individual needs with you.

If you are interested in time-sensitive care and evidence collection options, we recommend that you call the hotline 24/7 at 612-871-5111 instead of completing this form.

Please note that a trained rape crisis counselor will respond to your request within three business days. If you want to talk to someone before that, please call the hotline 24/7 at 612-871-5111.

Request an Appointment

Contact Information

Please enter the phone number(s) you would like to be contacted at below, using the following format: xxx-xxx-xxxx.

We want to make sure that we protect your confidentiality. The SVC phone number is blocked; this means it will not appear on your caller ID.

Is it OK to leave a voicemail?(Required)
Is it ok to say SVC on the voicemail?(Required)

Note about voice mail: If you do not have voice mail or if your mailbox is full, we will try several times to reach you. If you have not heard from us after several days, please call our office at 612-871-5111.

What services are you interested in?(Required)
What county do you live in?

What county did the instance of violence occur in?

I want to stay up-to-date with SVC. Please add me to the mailing list.

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