Intimate partner violence (IPV) affects millions of people each year, and healthcare settings play a critical role in early identification, intervention, and support. This Intimate Partner Violence Screening & Safety Assessment Form provides healthcare professionals with a confidential, trauma-informed tool to conduct validated risk assessments, develop safety plans, and connect patients with life-saving resources.

Built specifically for medical practices, hospitals, community health centers, and mental health providers, this template incorporates evidence-based screening questions aligned with clinical best practices and mandatory reporting protocols. The form uses conditional logic to adapt questions based on responses, ensuring a sensitive and appropriate assessment for each individual situation.

Paperform makes IPV screening more effective and compassionate. The form's clean, non-intimidating design creates a safer space for disclosure, while the platform's SOC 2 Type II compliance and robust security ensure patient information remains protected. Healthcare teams can customize the form to match their organization's protocols, add their branding, and integrate directly with their EHR systems or case management tools.

Beyond the initial screening, use Stepper (stepper.io) to automate critical follow-up workflows—instantly notify social workers or counselors when high-risk cases are identified, trigger mandatory reporting procedures when required, send resource information to patients via secure channels, and create follow-up appointment reminders. This automation ensures no patient falls through the cracks during a critical moment.

For organizations requiring documented consent and safety plans, Papersign (papersign.com) enables secure electronic signatures on safety agreements, release of information forms, and referral acknowledgments—all linked directly to the original screening for a complete, compliant audit trail.

Whether you're implementing universal IPV screening, conducting targeted assessments in behavioral health settings, or responding to patient disclosures, Paperform provides a dignified, secure platform that prioritizes both patient safety and provider compliance. Trusted by healthcare organizations worldwide, this template helps you fulfill your duty of care while treating every patient with the respect and support they deserve.