Third party referral form

Please note:

Our ISVA service is only available to boys and men living in London or where the offence happened in London.

If you are looking for an ISVA service for girls or women in London, please contact the London Survivors Gateway.

  • Section 1 - Referral Agency Information

  • If you prefer not to provide that information, please write N/A
  • If you prefer not to provide that information, please write N/A

  • Section 2 - Client Information

  • Section 3 - Alleged/Perpetrator Information

  • Section 4 - Reason for Referral

  • Section 5 - Additional Information (e.g. best time to contact to the client, other support services involved, health issues, additional risks)

  • Your details are safe with us - read our privacy policy.
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