Referral Form for External Organisations

Organisation Name:

Name of Referee:

Date:

Referee Email:

Client Name:

Client Phone:

Client Email:

Client Consent:

Has the client given consent for personal details to be shared with RPH?

Is the client happy for RPH to contact them by phone and/or email?

The client would like RPH to liaise with the referee directly

Best time to contact client:

URL of Content (where applicable):

Details of Issue:

Supporting Evidence:

Choose File

The Helpline can use the link you have sent to search for additional content online using a range of tools. If you are happy for us to do this, we need you to give us your consent and confirm the following (delete yes/no as applicable):

Permissions:

I consent for RPH to search online for intimate images that include me, report them for removal & take steps to prevent resharing of the image where possible

I confirm I am the person in the image/s sent to you & that I did not consent to have my images shared

I am 18 or over

I am in the UK

If I am acting on behalf of someone else, I have their permission to do so & the statements above apply to them

Once we have searched for further content we would like to ask how you would like to be updated with the reporting and removal process. We do not have to give you the full details of what we may find, and often find letting clients know the removal rate in percentages helps to ease any anxieties. You do not have to contact us every day, and if it feels more comfortable we can set some time aside a week to update you with our progress.

The Helpline will do whatever we can to find and remove intimate images of you that have been shared without your consent. However, there are never any guarantees with this: not all websites will co-operate and some will take some time to take action. We will do our best to keep you updated but please be aware we are a very small and busy team.

Digital Signature:

How can we help?

Information & advice

Referral Form

Your Details

Client Consent

Additional Information

Permissions