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Non-Urgent Referrals

IMPORTANT

Women’s Aid will attempt to contact any non-urgent referrals for support within 1-5 working days.


If you are in need of URGENT help, please call 999


If you need urgent refuge accommodation, please call us on 01472 575757

Women’s Aid North East Lincolnshire can only respond to enquiries from within our area.


If you are based elsewhere, please use the Women’s Aid Directory to find your nearest service.

Is it safe to contact you on this number?
Yes
No
Is it safe to contact you on this email?
Yes
No
Referred by
Do you have any substance misuse issues?
Yes
No
Do you have any mental health issues?
Yes
No
Are you on any medication?
Yes
No
Are you pregnant?
Yes
No
Have you got any current convictions or a history of violence?
Yes
No

To ensure we are compliant with the General Data Protection Regulation 2018, please give verbal consent for us to store, manage and retrieve any information (either personal or secondary) you are sharing with us in this instance.

Is this form being completed on behalf of a client?
Yes
No
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