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.


Independent Sexual Violence Advocate

Criteria:Female 16 years and over resident in the Leeds area. Appointments are held at out central Leeds office. We can offer outreach appointments (ie in schools/colleges) to 16 and 17 year olds.

About:Our ISVAs 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 available for women who wish to explore reporting to the police or have already done so.


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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Service Details

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