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Referral forms for Initial Assessments and Medico Legal Reports can be downloaded below.

The facility to refer online will be available by (TBC)


Initial Assessment

If you feel that your patient/client is torture survivor and may benefit from our rehabilitative services please refer by completing the initial assessment online referral form or submitting a hard copy referral form by email to or post to Spirasi. Please note that Spirasi will be moving to online referrals from (TBC).
The initial assessment referral form must be completed by a health care professional (GP or AMO). Applications should not be completed by the patient/client. Please complete in full Section 3 of the referral form to confirm that your patient/client fulfils our remit.


Medical Legal Report MLR

If your client is a torture survivor and may benefit from a medical legal report to support their asylum claim please refer by completing the medical legal report online referral form or submitting the form by email to or by post to Spirasi. The MLR referral form must be completed by the torture survivor’s legal representative and should be accompanied by documents listed in Section 9 of the referral form.



The cost of an MLR is €492. The Legal Aid Board LAB will cover the cost of the report for LAB clients and referrals through the Private Practitioner Scheme. A Legal Aid Board certificate must be submitted to cover the cost of the report. An invoice will be sent to private referrers.



Applications for initial assessment and medico legal assessment are reviewed by a remit panel to confirm that the patient/client fits our remit criteria.


The following questions will help you to answer if your patient/client fulfils our remit criteria linked to the UN Convention Against Torture UNCAT. Each question should answer yes.

1. Has your client suffered severe physical or mental pain or suffering?
2. Was the purpose of the ill treatment to obtain a confession; punish him or her for an act s/he or a third person has committed or is suspected of having committed; intimidate or coerce him/ her; or for any reason based on discrimination of any kind?
3. Was the actor of the persecution acting in an official capacity or with the consent or acquiescence of a public official or a member of a defined group with a common political, ideological or religious purpose or ethnic identity and exercising effective power?

Unfortunately, Spirasi has limited capacity and cannot accept every referral. People who have suffered torture by non-State actors are not excluded from our remit. Please see remit note attached for more detailed information.