Welcome to our online self-referral form
To self-refer, please fill out the form and click the 'Submit form' button. Our team
will give you a call to arrange a telephone assessment. You can expect a call from us
in 2 working days. We will try to contact you by telephone first and by email if we
are not successful.
We offer: therapeutic support (specialist sexual violence support + counselling)
advocacy support (ISVA + ChISVA)
To: Anyone who has experienced any form of sexual violence at any point in their life
- Who lives, works or studies in Lincolnshire
- We support all ages and all genders
- We also support those who are at risk of sexual violence, and those impacted by it (supportive family, friends and professionals)
We are a survivor focused organisation and as such we do not accept referrals for
anyone who is subject (the suspect) to an ongoing police investigation for sexual,
domestic or violent offences, or for anyone who may pose a risk of harm to others.
Required fields are shown in red.
