1. Has the physical violence increased in severity or frequency over the past year?

2. Does your abuser own a gun?

3. Have you ever left your partner in the past?

4. Has your abuser ever used a weapon against you or threatened you with a lethal weapon?

5. Does your abuser threaten to kill you?

6. Has your abuser ever strangled you?

7. Does your abuser control most or all of your daily activities such as who you can be friends with, how much money you have, using the phone, car, etc.?

8. Is your partner jealous? Accuse you of having affairs?

9. Does your partner stalk and follow you?

10. Do you have a child that is not your partners?

11. Does your abuser threaten to harm your children?

12. Does your partner destroy your personal property? Leave you threatening notes?

13. Has your partner ever threatened or tried to commit suicide?

14. Have you ever threatened or tried to commit suicide?

15. Is your partner an alcoholic or have a drinking problem?

16. Does your abusers behavior toward you change when drunk?

17. Has your partner ever forced you to have sex when you didn’t wish to do so?

18. If yes, is the sexual abuse frequent and/or severe?

19. Has your partner ever beaten you while you where pregnant?

20. Is your abuser unemployed?