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

Have you choked or burned your wife 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 wife?

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

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

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

How often have you hit your wife with a fist or with something else that could hurt her?

How often have you choked or burned your wife on purpose?

Has your wife hit you when you were not hitting her or had not hit her first in the last twelve months?

Have you hit your husband when he was not hitting you or had not hit you first in the last twelve months?