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Establishing and maintaining healthy boundaries is crucial in any relationship, including those within families. Boundaries help individuals define their personal space, emotional limits, and what they are or aren't comfortable with. When boundaries are respected, family members can enjoy a more harmonious and supportive environment. Print or type the document

Resources and Support

How to Use This Template

  1. Print or type the document.
  2. Fill in each section as completely as you can.
  3. Gather any evidence you have (photos, messages, medical reports).
  4. Make a copy for yourself before handing it over.
  5. Deliver the report to the authority or support service you trust (police, a crisis center, a lawyer, etc.).

1. Personal Information (Victim)

| Item | Details | |------|---------| | Full Name | | | Date of Birth | | | Address / Current Residence | | | Phone Number | | | Email (if you wish to give one) | | | Preferred method of contact | | | Relationship status / family situation | | a crisis center

5. Evidence (if available)

  • Photographs (injuries, location).
  • Medical records / forensic exam reports.
  • Text messages, emails, or social‑media messages that show threats or coercion.
  • Witness statements (names and contact info).
  • Any other relevant documents (e.g., diary entries, voice recordings).

Analysis

6. Desired Outcome / Next Steps

  • Report to police (yes / no).
  • Request for a protective order (if you feel unsafe).
  • Medical examination / forensic evidence collection.
  • Referral to counseling or a support service.
  • Legal advice (e.g., attorney, legal aid).
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