Lotus Justice & Support Centre

Professional referral

Complete the form below on behalf of your client. All fields marked * are required. The referral is confidential and will be read by Otilia Mutu, qualified IDVA.

If the client is in immediate danger, do not fill in this form — call 999.

Continuing a saved form?

1

Your details (professional)

Information about you as the professional making this referral.

Is the person aware of this referral and has she consented to Lotus contacting her? * (required)
Has a MARAC referral been made? * (required)
2

Client details

Personal information about the person you are referring.

If it isn't safe to give us your address right now, you can leave these fields empty.

Safe contact methods for client (required)
Does the client receive benefits? (required)
Does the client receive Universal Credit? (required)
3

Reason for referral

Describe the client's situation and the type of support needed.

Type of support needed (required)
Urgency of referral (required)
Assessed danger level
4

Risk assessment

Information about your professional risk assessment.

Is a safety plan in place?
Is the client aware you are making this referral? (required)
Has the client given consent? (required)
5

Safety questions

Complete based on the information you have about the client.

These questions help us understand your safety and are required. If you are unsure, choose "Prefer not to say". There are no wrong answers, and a full risk assessment will be carried out with an adviser.
1.Has the current abuse worsened or become more frequent recently? (required)
2.Are you very frightened? (required)
3.Have you been strangled/choked or threatened with a weapon? (required)
4.Has the person threatened to kill you or someone else, and did you believe them? (required)
8.Are there children or dependants at risk or harmed? (required)
6

Children and safety

Are there children in the household or involved in the situation? (required)
7

Other professionals involved

Add other professionals working with the client (optional).

These are case contacts, not the person making the referral. They will not receive the email copy.

Professional 1

8

Mortgage

9

Documents

You can attach up to 6 files or provide a secure link.

You can attach up to 6 files (photos, PDFs, Word documents). Maximum 12 MB total. Optionally, you can also add a download link.

Click or drag files here

Photos, PDF, Word — max. 6 files, 12 MB total

10

Declarations and signature

Confidential. Every referral is read by Otilia Mutu, qualified IDVA (Independent Domestic Violence Advocate).

Save and continue later

The form will be saved on our server for 7 days. A resume link will be sent to your work email. No notification is sent to Lotus and no reference number is assigned.

This referral is confidential. Data is processed in accordance with UK GDPR.