| 1- Does your partner put you down and call you names? |
| 2- Have you ever been slapped? Hit? Choked? Pushed? Bitten? Burned? |
| 3- Has your partner used a weapon against you? |
| 4- Has your partner ever made you do sometime humiliating or degrading? |
| 5- Does your partner embarrass you in front of others? |
| 6- Has your partner forced you to have sex against your will? |
| 7- Have you had bruises from being squeezed, pinched or held? |
8- Has your partner ever threatened you (or threatened to hurt you)
your children or other family members? |
9- Do you feel you are walking on eggshells to avoid upsetting
your partner? |
| 10- Has your partner ever threatened to kill you? |
| 11- Does your partner control where you go and who you see? |
12- Does your partner control all the household money and/or make you
ask for an allowance? |
| 13- Does your partner limit your use of a vehicle? |
14- Is your partner very jealous and suspicious of others or your
other relationships? |
| 15- Have you ever seen a doctor for an injury inflicted by your partner? |
| 16- Does your partner monitor all your time? |