Referral Forms
Below are the links to our referral forms.
You can refer yourself, or someone you know.
Please be aware that if you are referring on behalf of another person, you must have their permission to share the details prior to completing the form.
We aim to respond to your referral within 5 working days.
Our preferred method of contact is via our text messaging system; this is often the quickest way to reach us. If you would prefer for us to contact you in another way, please ensure the details on the form reflect this.
SARAC is not a crisis support service. If you, or someone you know is in danger, call 999 immediately.
Our Young Person’s Service offers emotional support from the age of 11. Sessions can take place at our centre in Burton or at an education setting. A parent or carer must give permission for anyone under 14.
There are different pathways within our Adult Services, offering a minimum of 12 counselling sessions at our centre in Burton.
We also offer specialist Secondary Survivor support for anybody who has been effected by a loved one’s experience of sexual violence.
To make a referral for secondary survivor support, please use the appropriate form above for the age of the person referring in to the service (not the direct victim).
If you require any support with referring in to SARAC, please call our confidential helpline and leave a message: 01283 517185.