Referral Form

We offer trauma informed therapeutic and advocacy support to anyone who has experienced any form of sexual violence at any point in their life. We also offer our services to those at risk of sexual violence and those impacted by it, such as family members and professionals.

We work with Adults and Children who are willing to engage in support/therapy relating to these experiences.

We will only accept referrals for those who are aware that their information is being referred to us. Please tick this box to confirm this. *  

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. By ticking this box, you and the person being referred agree for checks to be made regarding their risk status.

I hereby confirm, based on my professional judgment and assessment of risk, that the individual being referred does not pose a threat of harm to the clients or staff members of Lincolnshire Rape Crisis. Please tick this box to indicate your confirmation. *  

LRC reserve the right to refuse the provision of services. If you are unsure of the suitability of our services for the person that you are referring, please call us on 01522 716320 to speak to a Navigator.

Once we have received and processed this form one of our staff team will call the client you have referred to arrange a telephone assessment. They can expect a call from us in less than five working days. If it is not convenient for them when we call, we will arrange a suitable time to call them back. When we call them, they will have the opportunity to ask any questions they may have, and we will ask them for some more information about why they need to access support with us.

We will only disclose information to the referrer about the client’s attendance with written permission from all parties.

We will only disclose information to the referrer about the client’s attendance with written permission from all parties.

• Referring agencies must inform us of any known risks to or from the service user.
• We will not disclose issues discussed without the written consent of the service user unless there are safeguarding concerns.
• We must be informed by the referrer of the service user’s involvement with other agencies e.g. Social Services, Probation Services or Mental Health Services. This is particularly important if the service user is involved in care proceedings.

Required fields are shown with a *