Therapeutic Casework Unit Referral Form

Refugee Council, Therapeutic Casework Unit

Therapeutic Casework Unit Referral Form

Client’s Details
First Name: / Surname:
DOB: / Age: / Nationality/ Ethnicity:
Current Address: / Telephone No:
Languages spoken: / Interpreter required: Yes No
Language:
Interpreter: Male Female

British Refugee Council, (commonly called the Refugee Council) is a company limited by guarantee registered in England and Wales, [No 2727514] and a registered charity, [No 1014576]. Registered office: Gredley House, 1-11 Broadway, Stratford, E15 4BQ, United Kingdom. VAT registration no: 936 519 988

Refugee Council, Therapeutic Casework Unit

Immigration and Support Status
Just applied for asylum
Fresh claim/Appeal
Refused asylum
Other: / Date of arrival in the UK:
Income/monetary support:
GP address: / Telephone No:
Referrer’s Details
Name of Referrer and Organisation:
Address:
Tel No:
Date of referral:
Client Information & Presenting Problems
Please provide a brief history of your client’s human rights violations eg torture, sexual violence and rape, trafficking, political persecution, survivors of war or gender-based violence:
Mental health concerns or diagnosis:
Health issues:
Practical and/or social concerns:
Any other concerns:
Support requested (counselling/advocacy/woman specific service/young adults service/ health access support):
Other agencies involved (e.g. Freedom from Torture, Community Mental Health Team, Social Services, Domestic Violence agencies etc):

Please return this form to the Therapeutic Casework Unit email: