Revenge Porn Helpline

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Revenge Porn Helpline

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0345 6000 459

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Referrer Details

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Organisation (if regional please specify i.e. Victim Support Cumbria):

First Name:

Last Name:

Contact Number:

Email:

Victim Details

First Name:

Last Name:

Contact Number:

Has there been physical abuse or a threat of significant harm?
Did the physical abuse or threat happen within the last 2 weeks?
Has the Respondent abused the victim in the past?
Are bail conditions in place against the respondent?
Are you concerned about the safety or welfare of any children?

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DASH Score:

DARA Score / Priority:

Incident #:

Notes from referrer:

Has the Victim given consent?

Support for adult victims of intimate image abuse.