Support for adults (18+)

Referral for Adult Services (Professionals)

This referral form is for professionals wishing to refer their clients and should be used only where individuals do not wish to report their experience to the Police.

Our ISVA service supports clients who have recently reported or who are considering reporting their experience to the police, referrals to the ISVA service can be made here.

Does the client you are referring for support have any recent convictions (within the last 5 years) for any violent or sexual offences? If yes, please call us on 01226 320140 to discuss. If no, please fill in the remainder of the form.

* Denotes a required field

Referrer Details
Client Details

Can we text this number?

Can we leave a voicemail on this number?

Can we write to this address?

Can we write to this address on headed paper?

Are there any other services your client is currently accessing?

Has your client had any previous support which they found helpful or unhelpful?

Was the incident ever reported?

Does your client have a physical disability?

Once we receive this form we will be in touch with the client directly

We will add your client to our waiting list. For wellbeing and counselling we have a lengthy waiting list and it is unlikely we will be in touch before an appointment becomes available.

RCEW Helpline 0808 802 9999 (women and girls)
Safeline 0808 800 5005 (men)
Samaritans 116 123

In an Emergency call 999