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About us
Our Services
Price List
FAQs
Referrals

Families Contact

Home
About us
Our Services
FAQs
Price List
Referrals
Contact us

Home
About us
Our Services
FAQs
Price List
Referrals
Contact us

Referrals

We accept referrals from Private clients , Local authorities, Solicitors and other agencies. Feel free to contact us before completing referral form below

Please complete referral form below.

1

Referrers Details

2

Parents Details

3

Children’s Details

4

Risk Assesment

Role of Referrer

Self Refer Parent Social Worker Solicitor Professional Other

Name of Referrer

Surname of Referrer

If other Please Specify

Address

Post code

Telephone

Email Address

Which specific service(s) are you requesting in this referral?

Contact Supervision Supported Contact Virtual Contact Transport Services Handovers Family Support Welfare Check Bespoke Mentoring

Which would you prefer?

Community Contact Centre based Contact

Have you used another Contact Centre?

Yes No

Please provide centre name

Frequency of contact

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What time would you like for the service requested?

How many hours are required?

Is this referral Pre-proceedings or arising from Family Court Proceedings?

Pre-proceedings Family Court Proceedings

When do you need us to become involved?

Who will be funding this service?

Please give a summary of the reason for making this referral below (Background Family information)

Court Order, Section 7 Report or any relevant documentation

Your Contact Details

Mothers Details - Same as referrer?

Yes No

Full Name

DOB

Address

Email

Telephone Number

Occupation

Are you the resident parent?

Yes No

Father Details - Same as referrer?

Yes No

Full Name

DOB

Address

Email

Telephone Number

Occupation

Are you the resident parent?

Yes No

Child/Children’s details

Child 1 Full Name

DOB

Age

Child School Name

School Address

School Email Address

Additional Children

1 2 3

Child 2 Full Name

DOB

Child School Name

Address

Email Address

Child 3 Full Name

DOB

Child School Name

Address

Email Address

Child 4 Full Name

DOB

Child School Name

Address

Email Address

Any language barriers? (interpreter needed)

Yes No

If yes, please explain?

Any cultural or religious requirements??

Yes No

If yes, please explain

Do you have a allocated Social Worker?

Yes No

Social Worker Full Name

Email

Telephone

Do you have a Solicitor or Legal Representation?

Yes No Same as referer

Solicitors Full Name

Email

Telephone

Risk Assessment

Does any of the children have any illness, allergies, impairment, special needs or medical requirements?

Yes No

If yes, please provide more details

Does any of the adults involved suffer from long-term physical / mental illness or an impairment/ health concern?

Yes No

If yes, please provide more details

Are there any safeguarding concerns which we need to be aware?

No allegations Allegations on one or both sides Evidence / findings of the Court Sexual Abuse Child Abuse Domestic Violence Convictions Bail Non-Molestation Order Bail Condition Has any person who will be involved in the contact ever been convicted of an offence against a child/ren. Other

If yes, please provide more details

Are there any Family Law Act Orders in place or in the process of being applied for?

Yes No

If yes let us know which.

Date of submission of referral

By completing this Referral means that you are in agreement with Families Contact Terms and Conditions. The information provided will be stored and processed for the purpose of this enquiry and will not be shared, transferred or sold without consent

I understand and agree

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Welfare Checks
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Special Guardianship Assessment
Form F
Connected Person Assessment

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Please note this is our registered address, we have various Contact Centre's in and around London

Quick Links

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About
Services
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Services

Contact Supervision
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Handover Service
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Form F
Connected Person Assessment

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