Referral Form: Organisation

Before you begin

Before you begin completing this online form please note we are happy to answer any questions you may have however, we do not provide a crisis service.

SARSVL uses the information you give us for monitoring and reporting purposes. We keep clients’ information securely stored in our office and in online Data Performance Management System (DPMS). We do not share information with anyone else unless we are concerned about a safeguarding issue such as risk to the client and/or others or risk to a child. SARSVL will keep this information for 7 years after the client has stopped using the service after that time the information will be destroyed confidentially.


This form is for the ISVA Service only.

Independent Sexual Violence Advocate (ISVA)

About:

Our ISVA’s are trained in providing specialist trauma informed emotional support to help women throughout the life of a police investigation and beyond if the case gets to court. Emotional and practical support is also available for women who wish to explore reporting to the police.

At SARSVL we have ISVA’s who support women aged 18 and over, and a specialist Young Person’s ISVA who supports young women aged between 13 to 24.

We offer appointments to suit the client’s needs - they can be face to face in our Leeds Office, online, or over the phone. For young women aged between 13 and 17 we can offer outreach appointments such as in school or college.

Criteria:

Female, 13 years and over, and resident in the Leeds area. We will only accept referrals for those who have agreed to engage with us and who are aware that the referral has been made.

Once we have received the referral, we will contact the client within 3 workings days, to obtain more information in order to process the referral. 3 attempts will be made to attempt contact.

FOR REFERRALS IN RELATION TO YOUNG PEOPLE AGED 13- 16

Please provide the contact details of the parent/ caregiver under the client contact section of this form where the parent/ caregiver is aware of this referral.

A referral can still be made where the young person does not consent to their parent/ caregiver being informed of this referral. Please indicate if this is the case and we will complete a Competency Assessment with the young person.

Please complete the Form below with as much information as possible.

We will only accept referrals for those who have agreed to attend and who are aware that the referral has been made. SARSVL’s Office Coordinator will then make initial contact with the Victim/Survivor within 3 working days to arrange an assessment by phone for adult women and a face to face assessment for young women aged 16 and 17. Three attempts will be made to make contact.

Referring agencies must inform us of any known risks to or from the person referred.

Required fields are shown with a *

Referrer Details

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Organisational Unique Identifier Number
Essential Details

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Client Contact Details

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Additional Details

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GP Name / Practice or Surgery Name
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Assault Details (if known)

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(CSA means 'Childhood Sexual Abuse')
 (dd/mm/yyyy)
 (dd/mm/yyyy)

Please tick box below to show consent given for referral to support services*