Make a referral

A referral can be made by:

• anyone who is affected by domestic abuse or sexual violence, with or without children, currently or intending to live or work in Leicester, Leicestershire & Rutland (temporarily or permanently) and with or without the right to access public funds
• an agency on her/his behalf and with their permission
• an individual (friend, colleague or relative), again with her/his permission

To make a referral, complete the online referral form here: 

You can also download and submit a completed referral form via email to the following addresses:

Non-secure: [email protected]

Secure email: [email protected]

Please note that professionals will only be able to send emails to the secure email address if they are using a secure email account themselves (e.g. cjsm or pnn addresses).

To inquire about a referral form that has been submitted, please email [email protected].