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Referral Service

Would you like help and support after experiencing a crime?

The proaktiv – service centre refers you to a suitable specialist counselling centre, which will contact you promptly and advise you on all your questions and concerns.

Please fill out the referral form for this purpose.

All fields marked with an * asterisk are mandatory. Unfortunately, we are unable to refer you without this information.

    Referral form








    Any address where you can receive mail will suffice.



    The data from the fields with a grey background is transmitted to the specialist counselling centre.

    The following information helps us select the appropriate specialised counselling centre and remain with the proaktiv – service centre. What may have been the reason the crime was committed against you?








    By sending the form, I am consenting to the following:

    1. my personal data provided in this form may be transmitted in encrypted form to the proaktiv – service centre for the purpose of finding support services.

    2. my personal data indicated on this form may be processed by the proaktiv – service centre
      for the purpose of finding an appropriate specialised service centre for victims of crime for me.

    3. the proaktiv – service centre may forward the personal data from this form indicated in the field with a grey background to the selected specialised counselling centre via an encrypted process.

    4. the specialised service centre may use the personal data provided by me in field with a grey background to contact me for the purpose of an initial counselling appointment.

    5. even particularly sensitive data provided by me may be processed, if I have included them in the form.

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