Referral - North Sask Victim Services

REFERRAL

Our Referral form is meant to offer direct assistance or information regarding an individual affected by crime or a traumatic event and is available for anyone to submit. Examples of parties submitting referrals include:

Self Referrals

Referring Agencies

Anyone Concerned About an Affected Individual

Involvement with North Sask Victim Services is completely voluntary and confidential. All information is protected under provincial and federal privacy laws and will not be shared or acted upon unless there is evidence of immediate danger to oneself or others.

North Sask Victim Services does not disclose the source of the referral and support must be consented to by the affected party.

If you would like information and support without giving an affected party’s details, please call 306-425-3235 (collect calls accepted) or access the contact information of your local victim services office here.

Referral Form

Client Name

Client Phone

Client Email

Referring Agency Name

Referring Agency Contact Name

Referring Agency Contact Phone Number

Referring Agency Contact Email

Reason for Referral

Police File Number

Location of Client

Location of Incident Occurrence

Please list any outstanding needs or further services the client would like to be connected to

If this referral is coming from an agency, will you be continuing work with the client and/or will you require updates?

Yes No N/A

I confirm that client consented to this referral?

Yes