Referrer Details

Make a referral

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?

Best time to call:


DASH Score:


DARA Score / Priority:


Incident #:


Notes from referrer:

Has the Victim given consent?



 
- Quick Exit -
0800 101 7110
partners@domestic-abuse.co.uk
Quick Exit Site
White Ribbon Day 2026: Together We Mend

White Ribbon Day 2026: Together We Mend

by | Aug 21, 2026 | Campaigns

It Takes All of Us For White Ribbon Day 2026, Domestic Abuse Alliance is proud to launch Together We Mend – a collaborative community art installation created in partnership with artist and Violence Against Women and Girls (VAWG) campaigner Holly Ringrose....
Understanding the Language of Abuse

Understanding the Language of Abuse

by | Jun 11, 2026 | Resources

Understanding the language of abuse is not always straightforward. It may not begin with obvious harm or clear warning signs; more often, it appears in subtle words, shifting behaviours and patterns that can be difficult to name. For many survivors, the hardest part...