Sample Letter For Medical Evidence Of Domestic Violence Page 2

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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.
Yours sincerely,
[Sign]
[Name of Medical signatory]
[Title of signatory]
[Please indicate if signing on behalf of health professional colleague in their absence]
LA.DV.Med.ER_0413

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