OSARCC Referral Form

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 unless:
a young woman and girl or anyone under the age of 18 years old is in danger or at risk of significant harm.

Required fields are shown with a *

Referrer

Referrer Type*

Referrer Type 2*

Referring Organisation Name*

Person Making Referral*

Referrers Tel No*

Referrers Email Address*

Referral Date (dd/mm/yyyy)*

Person being referred

First Name*

Last Name*

Tel No*

Email Address

Address Line 1

Address Line 2

District*

Postcode*

Permission to Leave Voicemail*

Permission to Send Text*

Permission to Contact via Email*

Permission to send Post*

Date of birth (dd/mm/yyyy)*

GP Name / Practice or Surgery Name

Ethnicity 1*

Ethnicity 2

Ethnicity 3

Primary language*

Interpreter Required

Gender*

Sexuality

Religion

What is your employment/education status?

Disabilities*

Dependants

Any children and any adults who are dependent on your care

Dependant 1

Name

Gender

Date of birth

Dependant 2

Name

Gender

Date of birth

Dependant 3

Name

Gender

Date of birth

Your experience(s) of sexual violence

These fields are not required. Please leave blank if you are not comfortable answering the following questions

Which of the following best describes the abuse/assault?
(CSA means 'Childhood Sexual Abuse')

Reported to police

Crime Ref No

What is the perpetrators relationship to the client?
(e.g. friend, cousin, stranger)

Service information

Please select one of the options below.

IF YOU ARE UNSURE WHICH SERVICE IS APPLICABLE PLEASE CLICK ON THE SERVICE CRITERIA/EXPLANATION BELOW:

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

THERAPEUTIC SERVICES

Our therapeutic support services are a Support Group and up to 20 sessions of 1-1 Counselling. These are currently accessible for self-identifying women and non-binary individuals recorded female at birth.

The wait time for Counselling is currently around 18 months and the wait time for the Support Group is around 9 months.

We can also offer a Psychoeducation course held via video call weekly for 6 sessions, or access to our pre-recorded psychoeducation videos. The psychoeducation will explore the psychology of trauma and sexual violence and how it can impact your body and mind.

Our weekly Drop-in Groups can also be accessed whilst you are waiting for support. These groups include arts and craft, and yoga sessions, virtual coffee mornings and monthly webinars.

COMMUNITY INDEPENDENT SEXUAL VIOLENCE ADVISOR (ISVA)

Our Community ISVAs offer practical and emotional support for survivors of any gender in Oxfordshire who are considering reporting an experience of sexual violence, or who have already reported to the police. They can offer support with the reporting process, accompanying to meetings, and advocate on their behalf with the police and other agencies. We can also sometimes provide practical support with other issues related to the sexual violence you have experienced - e.g. housing, employment issues etc.

There is currently a TWO MONTH waiting time for our Community ISVA Service.

The Victims First Specialist Service may be able to offer support more quickly. You can contact them on 0300 1234 148.

OXFORD UNIVERSITY INDEPENDENT SEXUAL VIOLENCE ADVISOR (OxUni ISVA)

Our specialist university ISVA offers specialist advice, support and advocacy to students of any gender at the University of Oxford to help you come to decisions about what is right for you.

The ISVA is employed by OSARCC and is independent from the university. She can provide you with impartial information about your options following an experience of sexual violence including reporting to the police. If you decide to report, or have already reported, she can support you throughout the criminal justice process. She can also provide guidance and information on the complaints process and disciplinary procedures within Colleges and the University and can provide ongoing support. She can accompany you to meetings and advocate on your behalf with the police, your College, and other agencies.

SEE PROJECT/ChISVA

The SEE Project service supports young people self-identifying as female and non-binary individuals, recorded female at birth, aged 14 - 18 years old.

We offer specialist 1-1 Counselling which currently has a wait time of around 3 months.

We can also offer speciality Children and Young Peoples Independent Sexual Violence Advisory (ChISVA) support to young people 14-18 years of any gender identity, if they are considering reporting an experience of sexual violence or have already reported.

PLEASE NOTE

Our Listening services support all women, trans and non-binary people of all ages, with no referral needed.

We can discuss options for specialist support for men.

If you are male, trans male or non-binary recorded male at birth and seeking counselling or other therapeutic support, please see the services listed here: Counselling for Male Survivors

Additional information

Further information or issues relevant to this referral
(If you are a student at school, college or university, please provide additional info here e.g. the name of your school, college and course.)

Please tick box below to show consent given for referral to OSARCC services and agreement to OSARCC’s privacy policy*