• Criminal Justice Referral Form

    Thurrock Drug and Alcohol Service
  • Referral Date
     / /
    2 digit day, 2 digit month, 4 digit year
  • Does your service user live within the Thurrock?*

  • Support Services

  • Unfortunately, we can only work with individuals that live within Thurrock. If you are unsure what area you fall under, please enter your postcode into the Government Local Council website linked below. Please note that we only cover areas with a local authority of Southend-on-Sea Borough Council, or Southend-on-Sea City Council.

     

    https://www.gov.uk/find-local-council 

     

    If your service user lives in a region of Essex; please contact Open Road at the link below.


    Open Road Visions | Drug & Alcohol Recovery Service | Essex & Medway https://www.openroad.org.uk/  
    Contact Us - Open Road Visions


    If your service user lives in a region of Rainham; please contact Turning Point at the link below

    https://www.turning-point.co.uk/support-we-offer/drugs-and-alcohol  

    Otherwise, please contact us for more information.

     

     

  • Date of birth*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Gender*
  • Due date if known
     - -
    2 digit month, 2 digit day, 4 digit year
  • How can we contact {serviceUser} ? Please select all applicable.

  • Details of Referral Requirement(s)

  • Are you referring this client for an ATR or DRR Assessment?*

  • Please only tick Yes to ATR or DRR, if orders are active with start and end dates.

  • DRR
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year
  • ATR
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Can you please provide the next/upcoming Court date if known?*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Prison Release
  • From*
     - -
    2 digit month, 2 digit day, 4 digit year
  • To
     - -
    2 digit month, 2 digit day, 4 digit year
  • DTOA
  • Community Resolution
  • Licence
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Community Order
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year
  • PSS
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year
  • SSO
  • From*
     / /
    2 digit day, 2 digit month, 4 digit year
  • To*
     / /
    2 digit day, 2 digit month, 4 digit year

  • Neurodiversity

  • Does the client have or think they have a neurodiverse condition e.g. autism, ADHD, dyslexia?*
  • If yes, please specify which neurodiversity condition(s)

  • Risk Summary

  • Please select MAPPA level.*
  • Physical Health*
  • Psychological / Mental Health*
  • Self Harm*
  • Suicide*
  • Risk of Harm from Others*
  • Risk of Harm to Others*
  • Domestic Abuse*
  • Safeguarding*
  • Crime / Offending Behaviour*
  • Accommodation / Housing Risk*

  • Referrer Details

  • Does {serviceUser} know you are making a referral to The Forward Trust?*
  • Does {serviceUser} want to be referred to The Forward Trust?*
  • Would you like to receive feedback on the outcome of this referral?*

  • Supporting Documentation

  • Please upload any supporting documentation which may assist The Forward Trust with processing the referral to the secure upload below. 
     
     
    Supporting documents can include risk management plans, pre-setencing reports, previous offending information or medical information obtained from healthcare professionals.
     
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: