Certificate of injury template

This template can be used by a qualified health or medical practitioner to provide a report for an application for support under the Victims Support Scheme.

If you are providing a medical, dental or counselling report for a patient’s application for support under the Victims Support Scheme, you can use this template.

Visit Supporting documents for Victims Support Scheme applications to learn more about providing a medical, dental or counselling report.

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Download Certificate of injury template PDF 650.37KB File last updated on: 24 November 2025.

If you have any accessibility feedback or concerns related to this resource, please contact us.

Type: Template, Form
Author: Victims Services
Publication Date: 01 July 2021

Tagged in

Legal and justiceVictims Support Scheme
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