Safeguarding Referral

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First Name(Required)

Last Name(Required)

Email address(Required)

Please use an email address ending in thebraintumourcharity.org.

Please fill out this section with the details of the person at risk/raising the concern.

First Name(Required)

Last Name(Required)

Email address(Required)

Safeguarding Case Reason (other)(Required)

Safeguarding Concerns(Required)

Please give a summary of the context and concern you have for this person.

Protective Factors(Required)

Is there anything in place that reduces the risk? (eg. GP aware, good support networks, no plan or intent to act.)

Risk Factors(Required)

Is there anything that increases the risk? (eg. Lives alone, hasn’t told anyone else, history of similar issues, children involved.)

Your recommendations(Required)

Do you have any suggestions of what steps you feel need to take place?