FLOWS referral

This form is for front line agencies, and for statutory agencies such as the police or social services. Use this form to refer an individual to the FLOWS team. The FLOWS team can provide legal advice about a domestic abuse situation.

Please complete these details for the person you are referring. The FLOWS team will contact them on the next working day.

If you are a woman and need our help you can refer yourself directly to FLOWS using our self referral form.

Client’s name

Client's date of birth

DD/MM/YYYY
It’s very helpful for us to have the client’s date of birth so we can carry out a conflict of interest check before we contact them.

Day

Month

Year

Postcode

Phone number

Email address

When is it okay to contact the client by phone?

E.g. Any time, after 9:30am only.

Respondent's name

It’s very helpful for us to have the respondent’s name and date of birth so we can carry out a conflict of interest check before we contact the client. All details remain entirely confidential and the respondent will never be contacted.

Respondent's date of birth

DD/MM/YYYY

Day

Month

Year

Any other details about the client or their situation

Please provide any information that may help us when we contact the client.

I confirm this person has consented to a FLOWS referral being completed on their behalf

Please give us a little more information about this referral. We need to know who you are for monitoring purposes.

Your organisation

Your name

If we are able to contact you directly with any queries about this referral, please provide your contact details

Your email address

Your phone number