- Quick Exit -
0800 101 7110
partners@domestic-abuse.co.uk

Thank you for submitting your referral.

Our team will review the information provided.

If we need any additional details or have any questions, we will reach out to you directly. If you wish to contact us please telephone our helpline: 0800 101 7110 or you can email us at: weprotect@domestic-abuse.co.uk.
Domestic Abuse Alliance

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?