This form must be completed when making a referral

For completion by the referring agency

Victim details
Name
Address
Telephone Number(s)
Date of Birth / Gender
Offence/Incident details
(Please provide sufficient details including if Domestic, Sexual or Hate crime etc., also include names and DOB of any children residing with victim if relevant)
Preferred contact method – email, phone etc
If interpreter required / Language/s spoken:
Any Disability/Special needs
Specify any concerns about safety and methods of contact agreed, is it OK to leave voicemail message
Other information that may be useful with regards to support required e.g. emotional support, criminal injuries compensation, practical support.
Date of referral
Consent given for referral by victim? / Client verbally agreed: Yes No
Client signature ………………………………………………………………..
Contact details of organisation/person making referral :

Where to send this form:

Victim Support, 17-19 Falcon Road, Clapham Junction, London, SW11 2PH

Secure email –

Email -

Tel: 0207 801 1777

The offices are open 9am – 5pm Mon – Fri

For out of hours/weekend referrals please email:

Secure email -

Email -

Tel: 0845 450 3936

The offices are open 8am – 8pm Mon – Fri and9am – 5pm Saturday

The role of Victim Support

Help for victims

Support for anyone affected by crime –victim/s, friends and family. Our services are free and available to everyone, whether or not the crime has been reported and regardless of when it happened. We are not part of the police, the courts or any other criminal justice agency.

Our trained Victim Service staff and volunteers offer:

  • someone to talk toin confidenceto help you to cope with the emotional effects of being a victim
  • support you and other members of your family if necessary
  • information on police and court procedures
  • help in dealing with other organisations
  • information aboutcompensation and insurance
  • links to other sources of help and put in touch with other organisations
  • help you to deal with other agencies, such as the police or housing department

Victim Support may also refer to other agencies if intensive support or advocacy is requiredor may be more appropriate.

Help for witnesses

If you have witnessed a crime we can help you to cope with going to court by giving you information and support. Your family and friends who are attending court can gethelp too and we supportwitnesses for both the prosecution and defence. We also provide comprehensive support to children at court.

Our trained Witness Service staff and volunteers can give you:

  • someone to talk to confidentially, about how you're feeling before a trial
  • Information about what to expect in court, including a chance to see the court beforehand and learn about court procedures
  • a quiet place to waitbefore you are called to give evidence
  • someone to go with you into the courtroomif you want, to help you feel more at-ease
  • practical help (for example with claiming your expenses)
  • easier access to people, such as court staff,who can answer specific questions about the case
  • a chance to talk over the case when it has ended and to get more help or information.

For more information go to: