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Online Self Referral Form

Please fill in the form below or telephone our Helpline on 0115 941 0440.

Please fill in our online referral form below

To refer into our service, you must be aged 18 or above.  If you are under 18, please contact EMCYPSAS who will be able to help you and offer support.

If you are a professional making a referral, please click here to be taken to the professional referral form.

    Your Details

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    After you submit your form you will be taken to a thank you screen. If you do not see this or have difficulties with the form please contact our helpline on 0115 941 0440.

    news-briefing-reports-nsvss News, Briefings & Reports

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    We’re Recruiting

    We are looking for a dedicated Children and Young Person’s Crisis Support Worker to provide sensitive, client-centered, non–judgmental support to survivors, aged 17 and under, of sexual violence.

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    Use Your Voice

    Find out how you can use your voice to create change by giving feedback on our service and responding to government consultations.

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    Sexual Abuse and Sexual Violence Awareness Week

    Join us for a Week of Action from 5-11 February and show your support for survivors this Sexual Abuse and Sexual Violence Awareness Week!