Referrals

If you need our help, fill out the interactive referral form below or give us a call on 01582 341343. You can also request help for someone you know.

We’ll take some basic information to make sure we’re the right service for you or give you some advice about where else you can go.

We try and deal with all referrals as quickly as possible, but on occasions there may be a wait because of demand. If you need urgent support we’ll signpost you to our partner agencies.

  • Requesting Support For Myself

  • DD slash MM slash YYYY
  • If you select "Yes, if..." you will be asked to specify a safe method of contact. i.e. "Only ring after 2pm".

  • Requesting Support for a client / Someone I work with

  • 1. Information about the person making the referral

  • DD slash MM slash YYYY

  • 2. Client contact info

  • DD slash MM slash YYYY

  • Next of kin – who can we contact in an emergency?

  • Accessibility requirements

  • 3. Client equalities monitoring

    (Please tick any that apply)

  • 4. Client support needs/ vulnerabilities

  • 5. Children

  • 6. Alleged perpetrator/s

    Information about the alleged perpetrator, if known:

  • DD slash MM slash YYYY

  • 7. Reason for referral

  • Criminal Justice referrals - victims or at risk of (re)offending

  • Details of the person making the referral

  • Details of the woman being referred

  • DD slash MM slash YYYY

  • Referral Details

  • Please include data of arrest, custody record number and offence type if applicable

  • Possible support needs and/or risk factors

  • Other information you may feel appropriate to this referral

  • Please provide outcomes of THRIVE and/or DASH assessments if applicable.