Agency Court Support Request for Support

Court Support Agency Referral Form

Disclaimer

Please note that this support is for practical, emotional, and moral support to individuals navigating the family court system as victims of domestic abuse. This is not LEGAL representation.

Are you a professional who is referring your client

YesNo

Does the client live and/or have a court case in Berkshire?

YesNo

Are they over 18?

YesNo

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.

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? (This helps us understated if there is other support happening in tandem to court support)

YesNo

Is the client engaging with other agencies? i.e social services, CAFCASS

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. 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

What are the legal issues the client is facing? (you can select more than one)

DivorceSeparationFinanceChildrenProtection ordersOther

Please tell us what other 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. being a supportive listener, provide checkings before and after hearings, providing an understanding on post separation abuse) Moral support (E.g. moral support by attending court with a client, note taking at court)Other

Please tell us what other area of support they need

Do they have any upcoming court dates

YesNoNot sure

If they don't have a current court date please explain why they need court support? (this could be because they are going to apply in the next 6 months ect.)

Please tell us how many court dates you are aware of

Please note that we are not an emergency support and if there is less than 2 weeks until the court date we may not be able to provide the moral support in court. However if the client needs other support remotely that can be provided

Court date 1

Court location for court date 1

Court date 2

Court location for court date 2

Court date 3

Court location for court date 3

Court date 4

Court location for court date 4

Court date 5

Court location for court date 5

Do they currently have a solicitor acting on their behalf?

YesNoNot Sure

Please explain what the current state of the client's legal case is

Please provide as much information you have on the history of the court case and what is going on with the case that has triggered the need for support

What challenges or emotional barriers is the client facing that you believe will impact their ability to navigate the court process? Are there specific factors in their case that make court support essential?

About other people

In order to provide the best support we can we request the details of the person who has been abusing your client and the details of any children.

This information will not be used in any way other than to be able to progress their referral with Flag DV

Please consider providing this information now so as to reduce admin time and facilitate us being able to see your client as quickly as possible. If you cannot provide the information now then we will be required to ask your client for this information before we will be able to progress their referral

Abusers details

Their DOB (please leaveblank if not known at this time)

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

Their First Name

Their Last Name

Childrens details

Are there children under 18 involved

Yes

How many children under 18 involved

Details of their first child

Their full name

Their DOB