Have you threatened to use or actually used a gun, knife or other weapon against your partner in the last twelve months?

Have you slapped your partner or thrown something at her that could hurt her in the last twelve months?

Have you pushed, cornered, or pulled your partner’s hair in the last twelve months?

Have you kicked, dragged, beaten your partner in the last twelve months?

Have you hit your partner with a fist or with something else that could hurt her in the last twelve months?

Have you choked or burned your partner on purpose in the last twelve months?

How often have you threatened to use or actually used a gun, knife or other weapon against your partner?

How often have you pushed, cornered, or pulled your partner’s hair?

How often have you slapped your partner or thrown something at her that could hurt her?

How often have you kicked, dragged, beaten your partner?