Self Referral Form

Before you begin

This form is currently being developed and as a result we would ask you to contact us if you haven’t heard from us after a couple of days in case there has been an issue with the form posting.

Self-referring means you can contact us directly to access support.

There are just a few steps for you to take to help us offer you the right support.

To self-refer, fill out the information and click the ‘Submit form’ button. The form will be sent securely to Cambridge & Peterborough Rape Crisis Partnership. When we have received it one of our staff team will give you a call to discuss the next steps.

Required fields are shown with an *

If you are having problems completing this form or require any assistance, please contact the Peterborough office on 01733 225937.



    (further information can be found on the CAPRCP website)


  • 1. YOUR DETAILS



  • 2. INCIDENT DETAILS