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Group work referral form: Freedom / Phoenix / Breathe

Referral for (state Freedom, Phoenix, or Breathe):

Children's details



Is the client still in a relationship with the Alleged Perpetrator (AP)?
Has the Alleged Perpetrator used weapons against client and/or others?
Does the Alleged Perpetrator have a criminal history/conviction(s) for violence?
Has there been any threats or violence towards professionals by either the client or Alleged Perpetrator?

We cannot guarantee a place on the course until GDASS have reviewed all of the referrals to ensure that the group is suitable for all. If your client is not offered a place on the course we will discuss their options around support which may be more suitable to meeting their needs.

Please be aware the referral cannot proceed if information on this form is not complete.
If you have any questions, contact GDASS on 0845 602 9035.




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Phone: 01452 726570 or Email:

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