Agency Court Support Referral

Unable to accept self referrals

At this time we are unable to accept self referrals. If you need legal advice you can make a self referral to our legal advice service.

You may find it useful to visit our resources page to find other services that may be able to help. https://flagdv.org.uk/useful-resources/

Unable to accept referrals outside of Berkshire

Currently we are not able to accept referrals from other counties. You may find it useful to visit www.lawworks.org.uk as this is a charity who also offer free legal advice. Alternatively, the following services may be of assistance:

https://www.lawcentres.org.uk/i-am-looking-for-advice
otherwise your nearest Citizens Advice Bureau may be able to suggest additional local legal support.

If you are worried for your safety and in immediate danger, please phone 999. If you require the police but it is not an emergency, please ring 101. You may also wish to contact the National Domestic Abuse Helpline on 0808 2000 247.

Unable to accept referrals for under 18's

Currently, we are not able to accept referrals from people under 18. You may find it useful to visit....

https://www.lawcentres.org.uk/i-am-looking-for-advice
Advice Line - Specialist Youth Justice
otherwise your nearest Citizens Advice Bureau may be able to suggest additional local legal support.

If you are worried for your safety and in immediate danger, please phone 999. If you require the police but it is not an emergency, please ring 101. You may also wish to contact the National Domestic Abuse Helpline on 0808 2000 247.

About you, your organisation and client work done to date

Your First Name

Your Last Name

Your email address

Name of your Organisation

Please provide your organisation name

Best phone number for contacting your organisation

Have you completed a DASH/Risk Assessment with the client?

YesNo

What was the outcome of that assessment

Are there any details in the risk assessment we should be aware of?

Will the client continue to receive support from you after this referral

YesNo

Is the client engaging with other agencies?

About the client being referred

First Name

Last Name

DOB

Please enter your date of birth in dd/mm/yyyy format

Please enter the Postcode where the client is staying and click "Find my address"

Postcode

Address line 1

Address line 2

Address line 3

Town

County

Contacting the client

Is it safe to contact them directly?

YesNo

Please can you provide us with some details on a safe way to get in touch with them. Be sure to include either a phone number or email address in these details. Without these we will not be able to progress their case. These details could be your own if it is safer for contact to happen with you present.

Their email address

Their phone number

Is it safe for us to leave a voicemail message?

YesNo

Best days and times to contact them?

Do they need a translator

YesNo

Please indicate what language they require

About their support needs

Please tell us what legal issues they are facing

What type of support does the client require? (You can select more than one)

Practical support (E.g. explaining the court process and court etiquette) Emotional support (E.g. 1-2-1 support) Moral support (E.g. attending court with a client)Other

Please tell us what area of support they need

Do they have any upcoming court dates

YesNoNot sure

What is their upcoming court date?

What is the name of the court where the next hearing is?

Do they currently have a solicitor acting on their behalf?

YesNoNot Sure

Please provide a summary of the status of the legal case. E.g “wanting to apply” or “in court currently”

Is there any other information your would like to provide us about this client?

And lastly - A bit more about the client

Their ethnicity

What gender do they identify with?

Their Sexuality

How would they describe their religious affiliation or status?

Do they have any access requirements related to their disability you would like us to be aware of?

YesNoNot sure

Please describe their access needs

None	Physical Disability	Learning Disability
Hearing Disability	Vision Disability	Mental Health Disability
Long Term Condition	Speech Impairment	Disability Unknown

Court Support Agency Referral Form