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Self Referral Form

Before you begin

We are a victim focused organisation and as such we do not work with perpetrators of sexual, domestic or violent offences.

If you would like further information please contact the team on 01773 746115 to discuss support available.

THANK YOU FOR REFERRING TO SV2.

Please complete the form below with as much information as possible and ensure that the person you are referring is aware and has consented to the referral. The form will be sent via a secure connection (SSL), which is encoded and goes straight into our database, accessed by SV2 staff only.

You can see our privacy notice at https://www.sv2.org.uk/client-privacy-policy.php

Before submitting a referral please read the service criteria/explanation within the service details section below, this will help you to decide which service or services will most benefit the person you’re referring.

Upon receipt of the referral we aim to make contact with the survivor as soon as possible and this is usually within 5 working days.

Required fields are shown in red.

Support required
Please refer to our website for further definition of services available.

Service criteria /explanation of services (Click here to show/hide details)
Client Details

Additional Details

Biological Sex registered at birth
Gender identity
Please tick box to show consent given for referral to support services.