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Patient Handouts
For your patients
Domestic Violence Resources

Just Ask
Are you asking the question to screen patients for domestic violence? To assist in this effort, ISMA’s Family Violence Committee put together, Just Ask, a brochure that provides eight steps to screen and assist victims, and an assessment questionnaire.

Domestic Violence Information Guide
The Domestic Violence Info Guide is a free brochure created for both physicians and patients. The guide discusses the topics listed below.

  • The different kinds of abuse
  • How to create a safety plan
  • How to obtain a protective order
  • What to expect in court

The guide also provides a statewide list of shelters and non-residential support groups. This resource is free to download.

Domestic Violence Power/Control Wheel
The power/control wheel shows the different tactics an abuser may use to exert control over another person.

Domestic Violence Resource Cards
The Domestic Violence Resource cards are a small, easily concealable resource for patients who may be victims of abuse. They provide phone numbers to local shelters and non-residential programs. A safety plan is on the back.

Resource cards - $7.70 per 100 (Free to Members)
North - South - Central
Cardholders - $8.50 each
Refill orders on cards are free to members.
Order form

Domestic Violence Screening Forms:

This form provides a check-off list and a body diagram to help you record injuries. Download the form

Other Domestic Violence Resources:

ISMA e-Reports articles

Contact Rhonda Bennett to make orders
: Rhonda Bennett
Phone: (317) 261-2060
: (317) 261-2076




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