Help us understand how best to support the person you’re referring.
If you are a professional, agency, or community partner referring someone to HAVEN, please complete the form below. Your answers help us assess safety, understand the person’s needs, and connect them with the right support — whether that is refuge, case work, education programmes, or STAR Centre services.
You do not need to have every detail to begin. Answer as much as you can, and use Save and resume later if you need to step away and return. When you are ready, submit the form and our team will follow up as soon as possible.
Referrer questionnaire
This questionnaire has been created in order to ensure the safety of all and that the client being referred is suitable criteria for Mid-South Island Women’s Refuge & Family Safety Services’ Services – Please answer as much as you can.
There are two options for completing this referral.
- Use the form below, it can be completed in more than one visit. Click Save and Resume Later to store your answers and receive a link to continue when it suits you.
- Download a PDF here. Complete the form and email it to office@scwr.co.nz or return it to our community hub.