|This example letter has been designed by the Ministry of Justice to be used by doctors (including GPs), nurses, midwives, practitioner psychologists & health visitors (or, in the examining health professional’s absence, another health professional who has access to the applicant’s medical records), when responding to requests for evidence of injuries or condition consistent with domestic violence.
Information required is highlighted and instructions are italicised. Please delete any unnecessary text and instructions (including this introduction) before sending.
HEADED LETTER [Please can you ensure that the letter is on headed paper from the surgery or hospital where the doctor, nurse, practitioner psychologist, health visitor or midwife practises.]
[Your E-mail (if applicable)]
[Your Contact telephone number]
[GMC/NMC/HCPC] Registration Number:[GMC/NMC/HCPC] Registration Number]
Dear [Insert name of addressee],
Name of applicant: [Name of applicant]
I understand that [APPLICANT’S NAME] (‘the Applicant’) wishes to access legal aid for a family dispute as a victim of domestic violence. For this reason I have been asked to provide a letter in accordance with regulation 33 of the Civil Legal Aid (Procedure) Regulations 2012.
Accordingly I can confirm that the Applicant presented [himself/herself] to me [insert relevant health professional’s name] on the [DATE WHEN CONSULTATION OCCURRED] (being within 24 months prior to the Applicant’s intended application for legal aid). After examining them I [insert relevant health professional’s name] was satisfied that the [injuries [and/or] condition] that the Applicant presented me [insert relevant health professional’s name] were consistent with domestic violence.
I understand that the Ministry of Justice and the Legal Aid Agency recognise that the great majority of physical injuries and many non-physical conditions could be caused by domestic violence.
I understand that this evidence is only required for a decision on whether or not to grant legal aid – it is not designed to prove domestic violence in the context of a criminal or civil court case.
The applicant has confirmed that the [injuries/condition] that [he/she] presented to me [insert relevant health professional’s name] with on [date of consultation] were caused by domestic violence.
[Name of Medical signatory]
[Title of signatory]
[Please indicate if signing on behalf of health professional colleague in their absence]