Enquiry form: Survivors, family and friends

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.

If you are in danger call 999.

If not life threatening call Police on 101

If you live in the Bradford area then use the contact details below in case of an emergency

West Yorkshire SARC offers free support and practical help 24/7 to anyone in West Yorkshire who has experienced sexual violence and/or sexual abuse 0330 223 3617.

First Response offers 24/7 mental health crisis support 0800 952 1181.

Rape Crisis and Sexual Abuse 24/7 support line freephone 0808 500 222.

Bradford Samaritans freephone 116 123.

If you don’t live in Bradford please call our helpline FREE on 0800 448 0710 for information on services in your area.

There are just a few simple steps for you to take to help us offer you the right support.

  1. To self-refer, fill out the required information on the form below.
  2. Click the 'Submit form' button.
  3. The form will be sent securely to the Bradford Rape Crisis Helpline Team.
  4. When we have received your referral one of our staff team will give you a call from our FREEPHONE 0800 448 0710 number to complete the process within approximately 10 working days.
  5. Upon this call you will have the opportunity to receive information about our services. This is when you can ask any questions to help you decide about the type of support you would like to receive.

Required fields are shown with a *

In line with the current Data Protection Act (1998) and General Data protection Regulations (2018) we will not keep your personal information any longer than is necessary and will dispose securely of any information that no longer needs to be kept.

Main Details

Service Details

Please select one of the options below.
Explanation of services (Click here to show/hide details)
Client Contact Details

Additional Details

Are you are completing this form on behalf of someone else, if yes please provide your name and relationship to the above named person; in the comments box below. (Please note we can only accept this enquiry if the named person on this form is aware).

(Include info such as best contact time)

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