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Make A Referral

See below for the therapeutic support and ISVA referral form. If you want more information regarding counselling or our ISVA service please click the links below or alternatively call our helpline on 0300 303 4787, you can find our helpline times at the bottom of this page.

Therapeutic Support Referral Form

The RASAC Therapeutic Team provide short-term, therapeutic support services including; Counselling, Holistic Healing, Pre-Trial Therapy, Group Therapy, Art Therapy, and Support Sessions for survivors of rape, sexual and domestic violence, 13+, living in Kirklees, Calderdale and Wakefield. Please note, if you have received therapeutic support with us prior, we ask you wait 6 months from your last session before re-referring. For more immediate support or if you are experiencing difficult thoughts about harming yourself or ending your life please contact the emergency services on 999 or your local Crisis Team.

ISVA Referral Form

More information about our Independent Sexual Violence Advisor Service can be found on our ISVA Page.

Young People Support Group Referral Form

There are two young people’s support group one of which is for young women aged 13-17 and one for young men aged 13-17 who have experienced sexual violence/abuse. For more information, see our Group Therapy page. The group will be based in Huddersfield.

Family ISVA

For more information on our Family ISVA service, please see our ISVA Page.

Family ISVA

Name
MM slash DD slash YYYY
Address
Is it okay to:

Referrer Details

Name

Survivor Details

Name

Police Information

Perpetrator Details (If Known)

Name
Current & Recent Supporting Agencies
Name
Agency/Organisation
Contact Details: Tel No/Email
 

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