This referral has NOT been sent yet. You will be redirected to the listing's external referral form. Please complete the referral form there to submit the referral confirm Details Rubicon Cares - Medway by Rubicon Cares Who is this referral for? I am referring someone else Service access criteria Tick to confirm you have checked the service access criteria "Available to all across kent and Medway. Current counsellor locations are Medway, Maidstone, Ashford, Tonbridge - hence people need to be able to travel to one of these locations. Service for direct victim, family member or witness. Crime can be reported, unreported, historical or current. ages 13-18 (currently can only be seen in Ashford). Adults 18+, no upper age limit can access all 4 locations. We do not provide pre-trial therapy. " Your Details Email Email is invalid We already have an account with this email. Please log in. Password Reset my password Log in First name Last name Your relationship to the person Organisation name Who are you referring? First name Last name Known as Date of birth Email Don't know / client doesn't have an email address Phone Address Line 1 Address Line 2 Town/City Postcode GP surgery Gender SelectFemale Male Transgender female Transgender male Non-binary Intersex Not specified Not known Other Additional referral details Do not enter protected health information (PHI) or any other personal data in these fields. What are the reasons for this referral? victim of crime event/abuse family member of victim of crime/abuse witness to crime/abuse Other: This field is required. Should the service provider be aware of any additional needs? Blind/partially blind Memory problem Hearing loss Housebound Does not speak English Poor mobility Learning and communication needs Physical disability Frail Other: This field is required. Please share some brief details regarding this referral Date of Referral Referrer's contact phone number Confirmation and consent Tick to confirm you have gained consent to share this information with the service provider, your organisation and Joy Tick to confirm the service provider can directly contact the client Would you like to create an account? Make referrals faster next time you use Joy. Registered users can message service providers, submit reviews and track the progress of their referrals online. Password Weak password! Use at least 8 characters Use upper and lowercase characters (a-z) Use 1 or more numbers (0-9) Confirm password Please enter the same value again. required Submit Email: Password: Email
