FLOWS self referral

If you have been experiencing domestic abuse of any kind, we can help you access legal options to keep you safe. We can also help you find other specialist support.

Please use this form to send us your details securely. We will contact you within one working day. This form is entirely confidential, we will never share your details unless you ask us to.

Your full name

Your own name, that we use to address you

Postcode

The postcode for your own address

Phone number

Your own phone number

When is it okay to contact you by phone?

E.g. Any time / after 2pm only / never by phone

Email address

Your own email address, where we can contact you

Any other details

Please give some brief details of your situation and what you need help with

If you can give us some more details, it will help us to give you legal advice more quickly. The next questions are optional but it is very helpful if you answer them. All information on this form is completely confidential.

Your date of birth

Your own date of birth i.e. DD/MM/YYYY

Day

Month

Year

Name of other party

This is the person whose actions you are concerned about or who you need protection from.

Date of birth of other party

DD/MM/YYYY

Day

Month

Year

I consent to the FLOWS team contacting me

Please check this form once again before you submit it. Please ensure that you have entered the correct details and that the contact details are yours. We will be using the details and information provided to contact you to provide further assistance, it is therefore essential that these details are correct and are also safe forms of contact.