Referrals to specialist domestic violence support services: health professionals

Adapt this sample letter to answer requests for proof of a referral to specialist domestic violence support services.


If you’re a doctor, nurse, midwife, practitioner psychologist or health visitor, you can adapt this letter to give evidence of referring someone to a specialist domestic violence support service.

You can also use this letter if you’re a health professional and have access to relevant medical records but did not make the referral yourself.

Your evidence is required in cases of victims of domestic violence applying for legal aid. You can use this letter to provide evidence of a referral that took place up to 5 years earlier.

 Injuries consistent with domestic violence

Adapt this example letter to respond to requests for information about injuries consistent with domestic violence.

Domestic violence support services

If you work for a domestic violence support service, use this letter to confirm a referral from health professionals.