Survivor Pledge Form
Fill out the below to take the Survivor Pledge and receive your pledge badge.
Full Name:
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First Name
Last Name
E-mail:
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example@example.com
Organisation (You must be working in Health to take a Survivor Pledge):
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Take your pledge:
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I pledge to seek out and undertake education and training to properly understand domestic abuse and its impact, learn how to spot the signs and to adopt an approach that is both trauma-informed and inclusive in its recognition of how intersecting identities can create barriers for victim-survivors to access treatment.
I pledge to give victim-survivors my full attention during appointments and treatment and listen with care and understanding, recognising how difficult disclosing abuse can be.
I pledge to work collaboratively with victim-survivor patients to fully understand their experience and needs before deciding on a treatment plan.
I pledge to take appropriate risk and safeguarding measures to ensure that my patients have safety and privacy during treatment and can choose their next steps free from the coercion and stigma that can often lead to victim-survivors not seeking support and care.
I pledge to raise my own awareness of the domestic abuse support services and professionals available within my local area, so that I can properly refer and support my patients to specialist services.
I pledge to actively inform my patients of all their available options for treatment and referral, including follow up appointments and support services.
I pledge to ensure that the specific experiences of children and young people who have experienced domestic abuse are not minimised, but acknowledged and respected and that their insight is considered in developing a survivor-led practice.
I understand that I will be contacted to provide feedback on how I have implemented my Survivor Pledge into my Health and Social Care practice.
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I understand.
Signature
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