Domestic Abuse Advisory Hub Submission Form (1) NOTE: ALL INFORMATION RELATING TO THE FAMILY MUST BE ANONYMISED FOR THE PURPOSE OF DISCUSSION WITH EXTERNAL PROFESSIONALS. ANY SUBMISSIONS THAT CONTAIN PERSONAL IDENTIFIABLE INFORMATION WILL BE REJECTED.First Name* Surname* Email* Phone*Role* CSC or Family Thrive Team* Team Manager invited and agreed to attend?*YesNoTeam Manager's Name* Team Manager's Email: (Please note that your Team Manager will be invited to the Hub and recommendations emailed to them after)* Child Protection Chair invited and agreed to attend?*YesNoNot ApplicableChild Protection Chair's Name* Child Protection Chair's Email* LCS or EHM Number*I agree by attending the Domestic Abuse Advisory Hub that anything discussed will remain confidential unless we are worried about aspects of the case or that you, or someone close to, is at risk of harm. I also agree that all case information has been anonymised for the purpose of discussion with external professionals:Consent* I agree to the aboveProvide a summary of your concerns in relation to Domestic Abuse*What are you hoping to gain by presenting the case to the Domestic Abuse Advisory Hub?*Select Date*19th January 10.30 - 11.3019th January 11.30 - 12.3019th January 1.30 - 2.3019th January 2.30 - 3.3023rd February 10.30 - 11.3023rd February 11.30 - 12.3023rd February 1.30 - 2.3023rd February 2.30 - 3.3014th March 10.30 - 11.3014th March 11.30 - 12.3014th March 1.30 - 2.3014th March 2.30 - 3.30Disclaimer* I agree by attending the Domestic Abuse Advisory Hub that anything discussed will remain confidential unless we are worried about aspects of the case or that you, or someone close to, is at risk of harmPhoneThis field is for validation purposes and should be left unchanged.