This medical referral template was designed to support women’s self-advocacy with general practitioners when seeking medical assessment following non-fatal strangulation (NFS) and acquired brain injury (ABI). It will be useful to women’s health centres and other non-government organisations (NGOs) where women present after NFS and ABI in the context of sexual violence and require support to connect to the wider healthcare system.

This peer-reviewed medical referral template is designed to be downloaded and customised to your service. It will work best in conjunction with a referral pathway for NFS and ABI, appropriate protocols for using the referral pathway, and regular staff training.

Importantly, service providers should check with the woman about whether it is safe to print and offer this medical referral as a hard copy. In some cases, the woman’s safety needs might necessitate sending it directly to the nominated general practitioner as an electronic copy.

Service providers can gather valuable feedback about general practitioners on their referral pathway by following up with the woman after providing this medical referral letter. For further assistance using this medical referral template, please see the explainer.

Downloads (Click on the images below)

Download Print Version

Download Digital Version

Medical Referral Template for incidents of non-fatal strangulation and suspected brain injury
Download the Medical Referral Template Explainer