Ask for ANI report

Domestic abuse response in pharmacies monitoring form

The Home Office would like to understand how the 'Ask for ANI' scheme is being used, by whom and in what context, to inform its future development. We have therefore designed the following monitoring form for participating pharmacies to complete immediately after an individual who has sought help leaves the pharmacy premises. Please do not write your name or the name of the individual who has used the codeword anywhere on the form to ensure disclosures remains anonymous and confidential. 

Thank you in advance for your cooperation. Should you have any questions, please contact our partners, Hestia, at