Make a referral

Please complete this form if you want to refer someone else for support. This form will be sent to IDAS securely and the information will be held confidentially.

We will not share information with any other agency unless we are required to do so by law, or unless any person will come to harm if we do not share it. We may contact you for further information and to inform you of the referral outcome. All referrals are assessed and prioritised according to need and risk.

Referral form

Does the person you are referring need emergency accommodation or support in their own home?*

Emergency accommodation

Support in their own home

Please contact your local helpline on 03000 110110 (North Yorkshire / Barnsley) or Housing Solutions 0114 273 6306 (Sheffield) or the 24-hour national domestic abuse helpline on 0800 2000 247

Which service you are referring to?*

Please select what support you are referring to:*

Children Impacted by Domestic Abuse - Support for families where a child or young person has been affected by domestic abuse. Initial support is provided to the non-abusive parent/carer, with direct support for the child or young person considered following assessment

Child/Adolescent to Parent/Carer Abuse - Support for parents/carers who are experiencing abusive, violent or controlling behaviour from a child or young person within the family. Initial support is provided to the parent/carer.

All referrers will be invited to a referral discussion with the Family Service. The referral cannot be processed until this discussion has taken place*

I understand and agree to attend a referral discussion with the Family Service.

Your name*

First

Last

Your email address*

Your telephone number*

Agency you represent

Department you work in

Name of the person you are referring*

First

Last

Address of the person you are referring*

Address line 1

Address 2

City

Postcode

Date of birth of the person you are referring*

Are there any dependent children? Please enter their names and ages below.

Does the child/young person have any additional needs? E.g Neurodiversity

How can we safely make contact?

We must have details for at least one contact method in order to respond to your referral.

Please provide a telephone number or email address*

Is it safe to text?*

Yes

Don't know

N/A

Is it safe to leave a voicemail?*

Yes

Don't know

N/A

Is it safe to email?*

Yes

Don't know

N/A

If it is not safe to contact the person you are referring directly, please provide alternative details to support establishing safe contact and explain what this is

Does the person you are referring require an interpreter?*

Yes

Please state language or need*

What days and times is it best for us to contact the person being referred?*

What is the reason for your referral?*

Please provide as much information as possible including the nature of abuse and the type of support required.

Does the person you are referring have any connection to the military?*

Yes

Relationship status of victim and abuser*

Name of alleged abuser

Does the alleged abuser live at the same address as the person you are referring?*

Yes

Does the person consent to IDAS support?*

Yes

Are the police involved?*

Yes

Don't know

Police incident number

Has a Domestic Abuse Risk Assessment or DASH form been completed?*

Yes

Don't know

Please upload it here*

What is the level of risk?

Would you like to receive an email confirming this referral?*

Yes

Are you human?*

Make a referral

Please complete this form if you want to refer someone else for support. This form will be sent to IDAS securely and the information will be held confidentially.

Referral form

How can we safely make contact?

IDAS

What we do

Get in touch

Helplines:

03000 110 110 - Barnsley and North Yorkshire

0808 2000 247 - Sheffield