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Care Proceedings
Addendum Referral Form
(required in addition to the standard referral form
for parents involved in care proceedings regarding their children)
The information you provide is secure in transit and stored securely.
*Mandatory fields MUST be completed
Client's name:
*
Relation to child/children:
*
Mother
Father
Other
Other relation:
*
Name and age of child/children:
*
Name of other parent:
Are the parents currently in a relationship?
Yes
No
Unknown
At what stage in the proceedings is the case?
(Pre-birth, PLO, CLA reviews, final hearing, etc.)
*
Client’s solicitor’s details:
Brief summary of threshold/concerns:
*
Are there any accusations of physical abuse?
*
Yes
No
Unknown
Please explain about the accusations of physical abuse:
*
Are there any accusations of sexual abuse?
*
Yes
No
Unknown
Please explain about the accusations of sexual abuse:
*
Your name:
*
Your role:
*
Have you completed the standard advocacy referral form for this client?
*
Yes
No
This form will not be processed unless you also submit a standard advocacy referral.
This form will not be processed unless you also submit a standard advocacy referral.