Call 999 if you are in immediate danger

Professional referral

Please provide as much information as possible. If you have any questions, contact us on 01452 726 561 or email support@gdass.org.uk. 

Your details

Client's details

Date of birth 
Special needs 
Are they open to social care? 
500 words left
Are the client and abuser in a relationship? 
Are the client and abuser separated but living in the same property? 
Has your client consented to this referral? 

Abuser's details

Date of birth

Children's details

Client's children

Risk assessment

Privacy

Consent for storing and processing submitted data 

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