| Does your boyfriend/girlfriend ring you to see where your are or who you are with? |
a) Never
b) Often
c) Always |
| Does your boyfriend/ girlfriend always make excuses for anger or violence, such as ‘I’m sorry I just got jealous’ or ‘You just look so pretty so I…’ or ‘I didn’t mean to, it’s just…’ |
a) Never
b) Often
c) Always |
| Does your boyfriend/ girlfriend call you stupid, ugly, bitch, slut or idiot? |
a) Never
b) Often
c) Always |
| Does your boyfriend/ girlfriend tease your family, race, sexuality, religion or culture? |
a) Never
b) Often
c) Always |
| Does your boyfriend/ girlfriend stop you spending time with your friends/ family? |
a) Never
b) Often
c) Always |
| Does your partner ever say that they will ‘die if you leave me’? |
a) Never
b) Often
c) Always |
| Does your give you the ‘silent’ treatment for no reason? |
a) Never
b) Often
c) Always |
| Does your partner ever threaten to hit you or hit something to show you how angry they are? |
a) Never
b) Often
c) Always |
| Does your boyfriend/girlfriend ever touch you in a way that makes you feel uncomfortable? |
a) Never
b) Often
c) Always |
| Do you ever felt scared, frightened or nervous because of your boyfriend or girlfriend? |
a) Never
b) Often
c) Always |
| Do you feel as if your boyfriend/ girlfriend is watching you while you are at school or at home? |
a) Never
b) Often
c) Always |
| Does your boyfriend/girlfriend physically hurt you in some way, e.g. Slapp you, hit you, pull your hair, choke you or kick you? |
a) Never
b) Often
c) Always |
| Does your boyfriend/girlfriend insult your or embarrass you in public e.g. at parties, in front of groups of friends, in the school playground, in a busy street? |
a) Never
b) Often
c) Always |
| Does your boyfriend/girlfriend blackmail you to do things you don’t want to do, i.e. threatens to do or tell something as punishment if you don’t do what they want? |
a) Never
b) Often
c) Always |
Does your boyfriend/Girlfriend tell you what you can and can’t do, e.g. tells you that you can’t eat chocolate because you will get fat?
|
a) Never
b) Often
c) Always |
