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PARTNER RAPE
IS

REAL RAPE


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DOMESTIC VIOLENCE SERVICES DATABASE INPUT FORM

Please use the form below to put information about your service into the Domestic Violence Services Database.
Your information will appear when you have submitted it and filled in the CAPTCHA Spam-preventer.
Please note that you need to check the box that asks if you understand considerations about IPSV for your type of service (available here),
but you may leave any other field blank if it is not relevant.
However, please fill in as much as you can to ensure that survivors have sufficient information about your service.

Thank you so very much for your assistance with this project.

Your service recognises special considerations
for IPSV survivors? (Check for Yes)
Service Name:
Service Website Address?:
Country:
State/County/Region:
City:
E-mail Contact (if appropriate):
Phone Contact incl. area code (if appropriate):
Is there a Free Crisis Number?
Hours of Service Availability
(Crisis Line, other; if different services/hours, start new line for each).
Cost of Services (please choose):
If costed, do you wish to elaborate
(for example, can a client get reduced costs if she has a referral)?
What types and modes of counselling does your service offer
i.e. Crisis, short-term, long-term, telephone, face-to-face, email, online chat?
Counselling Approaches Used
i.e. CBT, Psychodynamic, Feminist-based, Combination (Please elaborate)
Other Services Offered i.e Police advocacy, Support groups suitable for IPSV survivors,
referrals to other community resources for abused women (Please elaborate):
Do you have a message of outreach
for IPSA survivors who may seek out your service?
Other information about your service you think is necessary?


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