SAND – SURVIVING ABUSE NORTH DEVON CIC

Confidential Referral

Referral Form for Specialist Counselling, Women’s Peer Support Groups & EMDR.

Referrals for Counselling,  EMDR and WPSG . Please continue with the referral below and on submission you will receive an automatic email response with your place on our waiting list. 

This form is for individuals and professionals wishing to refer into SAND for sexual violence support services. Please complete as much as you feel comfortable with. For urgent help, call Devon & Cornwall SARC (Sexual Assault Referral Centre) on 0300 303 4626 or dial 999 if you are in immediate danger.

This form should take no longer than 10 minutes to complete. Your time and effort in filling it out helps us make sure the right support is in place as quickly as possible.

Please be reassured that by submitting this form you will be secured a place on SAND’s waiting list and will receive an automatic confirmation email with your designated SAND number as soon as your referral is submitted.

Please note: DDAA (Devon Domestic Abuse Alliance)

If you feel that you are eligible to apply via the DDAA which includes SAND specialist counselling. please call 08082 816161 or make a referral here.

Who is making the referral? Before we begin… We know it takes real courage to reach out. Whether you’re completing this for yourself or on someone’s behalf, thank you for taking this first step.

Section 1: Referral Details

Section 2: Person Being Referred

Gender:
Safe to contact via:
SAND FORM: Please select the contribution band you can realistically afford for counselling sessions (per session):
Preferences
Living Situation:
Other Considerations:

Section 3: About the Sexual Violence

Type(s) of sexual violence experienced:
When did the abuse happen:
Relationship to person causing harm:
Has the abuse been reported to police:

Section 4: Support Needs

What support would you like from SAND:

Please Donate to SAND

We need your help to create a future free from sexual violence and all types of abuse. Your support helps us to pave the way to brighter lives for people affected by sexual violence, raise awareness and move towards our goal of a future free from abuse and fear.

Every donation, regardless of its size, has the power to transform lives, offering hope and healing to those in need.

Bank Details

Surviving Abuse Northern Devon cic {SAND}

Lloyds Bank

Acc: 37104960

s/c : 30-90-92

Paypal is admin@survivingabuse.org.uk

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