Professional Referral Form
Before you begin
This form is currently being developed and as a result we would ask you to contact us on 01733 225937 if you haven’t heard from us after a couple of days in case there has been an issue with the form posting.
Please complete the below form with as much information as possible. We may only disclose information to the referrer about the service user’s attendance with written permission from all parties.
We will not disclose issues discussed without the written consent of the service user.
We will only accept referrals for those who have agreed to attend and who are aware that the referral has been made.
• We will accept referrals for survivors of sexual violence, it does not matter if the assault happened recently or in the past.
• We will only accept referrals for clients residing in Cambridgeshire or Peterborough.
• We must be informed by the referrer of the service user’s involvement with other agencies e.g. Social Services, Probation Services or Mental Health Services. This is particularly important if the service user is involved in care proceedings.
• Referring agencies must inform us of any known risks to or from the service user.
• We are a victim focused organisation and as such we do not accept referrals for anyone who is subject (the suspect) to an ongoing police investigation for sexual or violent offences, or for anyone who may pose a risk of harm to others.
Required fields are shown with an *
If you are having problems completing this form or require any assistance, please contact the Cambridge office on 01223 313551.