Request Services

Fill out the form below, and a BARCC team member will get back to you as quickly as possible.

We’re Here for You

If you’re having difficulty finding information about the service you need, or if you’re not sure what type of help you need yet, please submit a request online below or call our office during business hours at 617-492-8306. Our service access team will explore your individual needs with you.

If you are interested in time-sensitive medical care and evidence collection options, or if you need immediate assistance, we recommend that you call the hotline 24-7 at 800-841-8371 or chat online 9:00 a.m.–11:00 p.m., instead of completing this form.

Protecting your privacy can feel especially important after a sexual assault. If you are concerned about your privacy rights, your safety, or that somebody else might find out that you are contacting us, please call our hotline at 800-841-8371 or our office during business hours at 617-492-8306, instead of completing this form.

If you have not heard from someone after several days, or if you have problems with this form, please call our office at 617-492-8306 to request services.

Questions marked with a star are required.

Providers: Providers: If you would like to refer a client to our services, please have them call us directly at 617-492-8306.

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Request Services

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Contact Information

Please enter the phone number(s) you would like to be contacted at below, using the following format: xxx-xxx-xxxx.
Please note that, to ensure confidentiality, we are unable to contact you via e-mail regarding requests for services.

We want to make sure that we protect your confidentiality. The BARCC phone number is blocked; this means it will not appear on your caller ID. We can unblock our number in order to call phones that do not accept blocked numbers. This means that our office number, 617-492-8306, will appear on your caller ID.

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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 617-492-8306.
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