Non-profit victim service agencies, advocates, and partnerships that provide services to survivors of domestic violence, dating violence, sexual assault and stalking may adapt these forms, policies and agreements for immediate use.  Use Step-by-step easy instructions!

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 agency or colocated partnership. This can be used to address visits to or meetings with clients, staff, or volunteers whenever there are confidentiality obligations.

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). To adapt the template simply:

  • 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. May be reproduced or adapted for nonprofit or educational uses with acknowledgement of authors and/or publisher.