Harmed by Psychiatry? Tell your story and report psychiatric abuse here

Introduction

Are you the abused person?
yesno

Your email*

Details of the abused person

First name *

Last name *

Address

Town*

Postcode

Telephone

Age

Gender malefemale

Your Details (if reporting about someone else)

Your name

Your telephone

Your relationship to the abused person

Details of the abuse

Type of Abuse That Occurred (Check as many as apply)

Summary of abuse that occurred *

Approximate date the abuse occurred

Approximately how many times?

Doctors & Location

#1: Facility where the abuse took place

#1: What county is the facility in?

#1: Doctor type:*

#1: Name of doctor(s)/psychiatrist(s) involved

#2: Facility where the abuse took place

#2: What county is the facility in?

#2: Doctor type:

#2: Name of doctor(s)/psychiatrist(s) involved

Any other information you would like to give?

What would you like to achieve as a result of reporting this abuse?

YOUR INFORMATION IS KEPT STRICTLY CONFIDENTIAL AND WILL ONLY BE USED WITH YOUR PERMISSION.

I HEREBY AUTHORISE THE CITIZENS COMMISSION ON HUMAN RIGHTS (CCHR) TO CONDUCT AN INVESTIGATION INTO THIS CASEOR: I DO NOT WISH ANY ACTION TO BE TAKEN. THE DETAILS OF MY TREATMENT ARE BEING SENT AS INFORMATION ONLY.