Has your spouse ever hit you with a fist or with something else that could hurt you in the last twelve months?

Has your spouse ever kicked, dragged, beaten, choked or burned you in the last twelve months?

Has a male partner ever threatened to use or actually used a gun, knife or other weapon against you?

Has any male partner ever threatened to use or used a firearm, knife or other weapon against you?

How many times has your spouse ever slapped you or thrown something at you that could hurt you?

Has any male partner ever slapped you or thrown something at you that could hurt you?

Has any male partner ever slapped or threw something in your direction that could hurt you?

How many times has your spouse ever pushed or shoved you?

Has any male partner ever kicked, dragged, hit, choked or burned you?

Has a male partner ever pushed or shoved you?