Safeline accepts referrals directly from survivors themselves, their friends and families or from professionals, providing the  person being referred is aware and gives expressed consent for the referral being sent.

Please ensure the form is fully completed otherwise it may result in a delay in processing your referral.

Please click on the relevant link below to download a referral form into our services;

Counselling Client Self Referral Form

ISVA Referral Form

Young People’s Prevention Services Referral Form

External Agency Referral Form

Please email completed forms to:  If you prefer to provide a telephone referral please telephone the main office on 01926 402498.

Your information

It is important to us that you understand how we may collect, use and store any data held about you which you can find by clicking on this page: Your Information

Please note:

Our service is focused on working with those affected by sexual abuse, rape and sexual exploitation and not on those that have committed sexual offences. Should you need to access support for those that have committed sexual offences, please visit Stop it Now.



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