This form is to refer yourself or someone else to OSARCC’s face-to-face services, including our services for adults and our SEE project (for young women aged 14-18).
Please complete this form with as much information as possible. If there is a question you feel uncomfortable answering here and would prefer to discuss in person, feel free to leave it blank.
If you need support to complete this form, please contact us on 01865 725311.
We would recommend that survivors who require support refer themselves directly. However, if they are not able to do this, professionals and supporters can also make a referral via this form. You must have the consent of the survivor to make a referral to any of our services on their behalf. Please do not refer anyone unless they have given their explicit consent.
The SEE Project services are confidential and the information provided by survivors is confidential unless we believe any child or young person under the age of 18 years old is in danger or at risk of significant harm.
Make a self referral
Do you have the survivor’s explicit consent to being referred? If you do:
Make a 3rd party referral