This form is to refer yourself or someone else to OSARCC's face-to-face services.
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.
Your information will be kept safe and treated with care and respect. Information will be shared
where there is a legal obligation of safeguarding concern/risk. Your personal information will not be
shared with anyone outside of OSARCC without your explicit consent in line with the principles of the
Data Protection Act 1998.
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 on their behalf.
The SEE Project services are confidential and the information provided by survivors is confidential
a young woman and girl or anyone under the age of 18 years old is in danger or at risk of significant
Required fields are shown with a *