Make a referral

If you would like to make a confidential referral to the Aura service, please complete the form below as much as you can, including safe contact details.

You will be contacted by an Aura support worker within 3 working days, who will provide personalised support in a way that works for you. We can support you to explore your options and make safe choices for yourself and your family. Everything you tell us will be confidential.

You can also contact us via email at aura@sacro.org.uk.

Speak to us online through our live chat at the following times:

Monday 10am-12pm

Wednesday 1pm-3pm

Thursday 6pm-8pm

Or telephone us on 01698 757667

Aura is not an emergency service. If you think you are in danger, please call 999.

Fields marked with a * are required.

Please select the type of referral you wish to make: *--- Please choose an answer ---Self-referralAgency referralReferring a friend/family memberOther (please specify below)

Name: *

Telephone number: *

Email address:

Date of birth: *

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Address:

Gender: *--- Please choose an answer ---Male (including FTM trans men)Female (including MTF trans women)Non-binaryOther (please specify below)

Any other information you would like to tell us to help us best support you:

Best way to contact: *--- Please choose an answer ---Call mobileText mobileEmailPostCall landlineOther (please specify below)

Pregnant? *--- Please choose an answer ---YesNoNot applicable

Referrer contact details (if you are referring yourself, please leave this section blank)

Name:

Address:

Organisation name (if applicable):

Telephone number:

Email address:

Role:

Relationship to referred person:

Are you working with any other agencies: *