Dorcas Referral

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Date Of Referral: June 4, 2026

Confidentiality statement: Everything you discuss with us will be held confidentially, unless there is a danger to yourself or someone else, then we have a duty to disclose to the appropriate safeguarding authorities. Your personal information you share with us, will be held on our secure system and will not be shared with anyone else.
We will always seek you consent before making a referral to a third party.

Yes No

Agency information

Agency

Contact Name

Contact Telephone

Contact Email

What is your involvement with the referral

Client Details

Client Name

Date Of Birth

Landline

Address

Safe To Call

Yes No

Mobile

Email Address

Safe to write to address given

Yes No

Spouse Details

Martial Status

Sexuality

Disability

Ethnicity

Religion

Where did you hear about DORCAS

Children and Family

Name of Child

Male / Female

Date of Birth

Address

Living With Client Yes / No

School

End of child fields

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Type of FGM

Type 1

Type 2

Type 3

Type 4

Any Other Information

Reason For The Referral

What is the main reason for the referral to DORCAS?

Brief Overview of Situation

Consultation notes:

Committed to fostering healing and wellbeing, DORCAS offers comprehensive emotional, practical, and health support to survivors of FGM and abuse, building stronger, resilient communities for all, including asylum seekers and refugees.

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CLICK TO MAKE A REFERRAL FOR SUPPORT

Date Of Referral: June 4, 2026

Agency information

Client Details

Children and Family

Type of FGM

Reason For The Referral

Important Links

Donate Us

Charity No. 1194064

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