Chat Registration:

The following is used for conversational purposes only and is optional.
First Name
Last Name
Postal code/Zip code *  

Thank you for contacting NOVA. NOVA supports, counsels and empowers victims of sexual assault and other serious crimes in Bucks County and works to prevent and eliminate violence in society through advocacy, training, community education and prevention programs.


As such, our funders require we ask the following questions to gather demographic information. This information will remain confidential. We understand your experience may fall outside of these binary questions. You will have the opportunity to discuss your experiences and needs with the counselor.
Please note that NOVA staff are mandated reporters by law.  If abuse of a child is disclosed, we will be required to contact Childline.

Please complete your date of birth if you are contacting us on your own behalf.  If you are calling about another person, please enter their date of birth if you know it, or their Age Range if you do not.
Date of Birth
Age Range * 
Gender * 
Race *

Relationship to Person in Need * 
In order to follow-up regarding our services, please provide your phone number

To enable Google Chat or SMS (text) communications please provide the following info:
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Verification: To complete the registration, solve the CAPTCHA and click "Start".
(this additional step helps prevent malicious and automated attempts to access the site)