Sexual Assault Exam Request Form
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Sexual Assault Exam Request Form
This form is used to request a sexual assault exam.
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Personal Information
Description:Request a Sexual Assault Exam
The Sexual Assault Exam Request Form is designed to help victims of sexual assault request an exam. This form is confidential and secure. It is important to fill out the form as completely as possible to ensure that you receive the appropriate care. The form will ask for your personal information, the date and time of the assault, and any other relevant details. Once you submit the form, a healthcare provider will contact you to schedule an exam. The exam is free of charge and can be done at a hospital or clinic. It is important to seek medical attention as soon as possible after a sexual assault to ensure your safety and well-being.
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