National Network to End Domestic Violence Official Website

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Visitor Confidentiality Agreement

The purpose of this Template Visitor Confidentiality Agreement is to ensure that each visitor to a shelter, rape crisis center, transitional housing, family justice center or other victim service agency understands their confidentiality obligations and respects the privacy of clients, staff, and volunteers of the individual agency or/and colocated partnership of agencies. This can be used to address visits to or meetings with clients, staff, or volunteers whenever there are confidentiality obligations to uphold.

Organizations are welcome to adapt this template agreement to fit your needs and the work you do. You may change wording to match the language your agency or partnership prefers (e.g., survivor, client, victim, service participant).

Instructions to adapt the template:

  • add information relevant to your specific agency, program or partnership;
  • insert or delete optional information as indicated in yellow.
  • insert your [program/agency/partnership/collaboration names] and letterhead;
  • remove generic template instruction notes and other notices from the top of the agreement.

Distribution Permissions: Published September 2011. This piece may be reproduced or adapted for nonprofit or educational uses with acknowledgement of authors and/or publisher.