If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email firstname.lastname@example.org.
Please tell us what format you need. It will help us if you say what assistive technology you use.
If you’re a doctor, dentist, nurse, midwife, practitioner psychologist or health visitor, you can adapt this letter to give evidence of diagnosing injuries or conditions consistent with domestic violence.
You can also sign this letter if you’re a health professional and have access to relevant medical records but did not make the diagnosis yourself.
You need to give evidence when victims of domestic violence apply for legal aid.
Adapt this example letter to respond to requests for information about referrals to specialist domestic violence support services.
Domestic violence support services
If you work for a domestic violence support service, use this letter to confirm a referral from health professionals.
If you work for social services dealing with domestic violence or child abuse, use this letter to confirm completion of a domestic violence assessment.