Women's Research Center

Intimate Partner Violence Checklist

Below are listed various forms of behavior. Please rate if your partner (or ex-partner) has had some of these behaviors with you and with what frequency?  Please indicate frequency from 0 to 7: 0 = never happened to me to 7 = happened to me every day.

Please indicate frequency from 0 (never happened to me) to 7 (happened to me every day)