Understanding Our Referral Process

Self Referrals

If you reside in Torbay and have been impacted by Domestic Abuse (including Domestic Violence, Coercive Control, and Economic or Financial Control) or Sexual Abuse, and are experiencing mental health challenges, addiction, or housing difficulties as a consequence, you are invited to self-refer to Torbay Ladies Lounge. We provide all our services free of charge to our clients. Kindly complete the confidential form below, and a member of our team will reach out to you shortly. Whenever possible, we would prefer if a trusted family member or a professional does the referral on your behalf.

Agency Referrals

Our referral process is designed for professionals such as social workers, healthcare providers, educators, and other community practitioners who wish to guide their clients towards our services.

If you are a professional looking to make a referral, we invite you to fill in the referral form below.

Referral Submission Form

Client Name*

This field is mandatory

Client Address*

This field is mandatory

Client Date of Birth*

This field is mandatory

Gender*

This field is mandatory

Client Phone Number*

This field is mandatory

Does the client have a criminal record - please note any information given will be treated in a non-judgmental way. If YES, please provide details*

This field is mandatory

Brief description of Domestic Abuse or Sexual Abuse*

This field is mandatory

Does the client have Drug or Alcohol Dependency issues? please provide some details*

This field is mandatory

Is there anything else we should know?*

This field is mandatory

If you are an Agency or a Trustee Friend of Family member, name of Agency and name of Referring Person*

This field is mandatory

If you are an Agency, please seek consent from your client. Has your client given consent for this referral?*

This field is mandatory

Next of Kin name, relationship to client and phone number*

This field is mandatory

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

* Indicates required fields

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