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Shropshire Domestic Abuse Service Referral Form

How to complete this referral:

By completing this referral form, you’re helping us to make contact with the client as safely and quickly as possible.  We’d appreciate it if you could include as much information as possible - this saves the client from being asked the same questions twice and helps us to understand more about their particular needs and circumstances, particularly in Section 7

Eligibility criteria for this service:

Please be sure to check that the client meets the following criteria before making the referral:  

  • For Safe Accommodation in Shropshire: Is a person aged 16 or above who has been a direct victim of domestic abuse either now or at some point in the past, and is requiring immediate safe accommodation.
  • For Support in Telford & Wrekin Safe Accommodation: Is a female aged 16 or above who has been a direct victim of domestic abuse, and is resident in Telford and Wrekin safe accommodation.
  • For Outreach: Is a victim aged 16 or above who has been a direct victim of domestic abuse either now or at some point in the past, and is requiring emotional and practical advise and guidance.  They must live in the Shropshire or Telford and Wrekin area to access this service.
  • For Outreach – Polish Community: Is a Polish victim aged 16 or above who has been a direct victim of domestic abuse either now or at some point in the past, and is requiring emotional and practical advice and guidance.  They must live in the Shropshire or Telford and Wrekin area to access this service.
  • Shropshire Groups Is a victim aged 16 or above who has been a direct victim of domestic abuse either now or at some point in the past, and would benefit from attendance on a Group.
 
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Information about the person making the referral
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Client Contact Information
Next of Kin