Details of the person being referred for Family Counselling

Details of the survivor

If you are referring from an agency, please add your details  here    *Please note: We will be able to confirm receipt of a referral, but we cannot give any other information to referring agencies without the client's consent. As the agency, you are responsible for the safeguarding needs of your client.*

In order for RASASC to meet the aims and commitments set out in its equality policy, including not discriminating under the Equality Act 2010, we need to build an accurate picture of who we support in order to encourage equality and diversity. The anonymised data is also required by our funders, and improves our ability to apply for funding.   We need your help to enable us to do this, and we’d be grateful if you could complete the following questions:

Please read our Privacy Policy to understand how we use your data