Referring an adult
Referring an adult
This referral form helps us make to contact as safely and quickly as possible, and ensures we offer the right service based on need and risk. If you are self-referring, please select “for myself” on the first question or if you are utilising our external link form below, please type “Self” in the referring agency field.
Please complete the form fully and accurately, as missing information may delay our response and could affect service access.
You can access our referral form using the button below.
Professionals only – DASH Risk Assessment required:
A DASH risk assessment must be completed and uploaded to this form to progress the referral. Please include as much detail as possible in the DASH comments section.
If the client answers Yes to 14 or more DASH questions, you must make a MARAC referral to the victim’s current Local Authority. If you need support completing the DASH or making a MARAC referral, please contact the team on 0161 872 7368.
All referrals must include a completed DASH form. You can download the form here and upload it to the referral before submission.
Eligibility Criteria (Refuge Service):
Our refuge service is for anyone aged 18+, with or without children, fleeing domestic abuse. We will consider referrals including individuals who have:
- Mental health needs
- Substance misuse / dependency
- Alcohol dependency support needs
- Previous refuge eviction
- Experience of offending