Service you are referring to*

    Have you completed a Merit or DASH assessment?*

    If a Merit / DASH assessment has taken place, what is the level of risk? (Please select an option)

    Sexuality of the person you are referring

    Are there any dependent children? (please provide names/age/address if different from referral)

    Safe contact details for person you are referring

    Is it safe to text?

    Is it safe to leave a message on mobile?

    Does the person you are referring require an interpreter?

    Are the police involved?

    Does the person consent to LDAS support? For LDAS to make contact the referrer must obtain consent.*