Lamplight API response

First name

Last name

Address 1

Postcode

Email address

Mobile phone

Phone number

We will need to contact you following your referral. Please ensure that you share permission contacts with us so we are able to reach you in the way that suits you. Please note that our text system can often be the fastest and easiest way to contact us.

By post

By email

By mobile

By text message

Other information

Contact and Client Details (we ask for details around protected characteristics to ensure our service is accessible for all. Please answer what you are comfortable to share)

Home phone

Send a text message (via our Text Magic messaging system)

Date of birth

Pronouns

Gender

Sexuality

Ethnicity

Any accessibility needs (e.g. learning difficulties, disabilities)

Information disclosed

Disclosure details (in your own words please share what you are comfortable to about the experiences that bought you to SARAC)

Was legal action taken?

Criminal Justice Process completed?

Trauma Responses

Anxiety/Panic attack

Depression

Blank out/ lose time

Any other mental health issues as a result of the trauma?

Any other challenges unrelated to sexual abuse? (Additional information shared)

Have you ever had specific support for sexual violence from SARAC or anyone else?

How you hear about SARAC?

Referer information (if you are referring on behalf of somebody else, please give details of your relationship to the client and contact details)

Secondary Survivor Support

Other information

Contact and Client Details (we ask for details around protected characteristics to ensure our service is accessible for all. Please answer what you are comfortable to share)

Information disclosed

Trauma Responses