Submit a self or professional referral ONLINE REFERRAL FORM

Online Referral Form

Access Support Now

You can access free Counselling and ISVA support services through Savana by submitting an online referral form below.

If you or someone you know has been affected by sexual violence and abuse and needs support you can access our self referral form and professional referral form below.

*please note we can only take referral from the Stoke-On-Trent area.

How to make a Referral

Choose the Appropriate Form: Depending on whether you are a survivor seeking support or a professional making a referral, select the relevant form.
Provide Details and Relevant Information: Fill in name, contact information, and any other required details.
Submit the Form: Once you have filled out the required fields, click the “Submit” button to send the form to our services team.

Follow-Up: Our dedicated team will review your referral promptly and reach out to you or the individual referred to discuss the next steps to book an initial options appointment (IOA) .

Please note* if a professional fills in a self referral form rather than a professional referral form the referral may not be processed.

If you are making a referral for yourself, a family member or friend please use our self-referral form by clicking here. Or use the button below.

If you are making a professional referral please use our professional referral form by clicking here. Or use the button below.

*Please Note: we can only take referrals if the named person on the form is aware of the referral. Referrals made via our online referral service will only be accessed during office hours 9am – 5pm Mon – Fri.

Savana's Services Include:

Counselling and Therapeutic Work

We offer person centered counselling to survivors of rape, sexual violence and abuse provided by qualified counsellors. Supporters and Carers of the survivors may also access the service if they have been affected by the survivors experience of sexual violence and abuse.

Click here to find out more about or free counselling service >>

Independent Sexual Violence Advisor (ISVA) Service consists of:

Independent Sexual Violence Advisors (ISVAs) who provide support to survivors 18+
Children and Young peoples Sexual Violence Advisor (ChISVA) who provide support to under 18’s (and 18-25 where required)

Click here to find out more about or free ISVA service >>

Find Us

Location

Savana

Unit C, Metro Business Park,

Clough Street, Hanley

Stoke-on-Trent

ST1 4AF

Our Hours

Monday 9 am–8 pm
Tuesday 9 am–8 pm
Wednesday 9 am–5 pm
Thursday 9 am–5 pm
Friday 9 am–5 pm
Saturday 9 am–2 pm
Sunday Closed

Contact us

Phone: 01782 433204 / 433205
Email: info@savana.org.uk