№ lp_2_3_61595
Administrative referral form issued by a domestic abuse support service in Southwark for collecting client, children’s, and alleged perpetrator information and specifying requested support services.
Organisation: Southwark Domestic Abuse Service
Associated Organisation: Refuge
Service Area: Southwark
Country: United Kingdom
Document Type: Referral form
Purpose: Referral to domestic abuse support services
Services Available: Independent Gender-Based Violence Advocates (IGVAs); Sanctuary Scheme; IRIS Advocate Educator; Perpetrator Service; Survivor Group Work; Counselling; Children’s Therapeutic Support
Referral Submission Method: Email
Contact Telephone: 0207 593 1290
Referral Requirements: Victim consent; parental consent if under 16
Client Information Collected: Personal details; contact information; demographic data; immigration status; health needs; GP details
Children’s Information Collected: Names; ages; gender; education details; residence; relationship to perpetrator
Perpetrator Information Collected: Name; date of birth; gender; address; relationship to survivor
Additional Information Requested: Details of incident; police involvement; other agency support; existing court orders
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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