Make a referral

Make a referral

Any organisation or individual can make a referral. If you refer yourself for support, we will direct your referral form to the appropriate service and someone will contact you within 72 working hours.

All information is stored securely and we will treat your information as confidential and will not share it 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. If you are a professional referring a client, 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

Address line 1

Address 2



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

If you are referring yourself, only tick 'yes' if you are sure your email is safe.