Have you pushed or shoved a partner in the last year?

Have you kicked, dragged, beaten, choked or burned a partner in the past year?

Have you hit a partner with a fist or with something else that could hurt her in the last year?

How many times you ever threatened to use or actually used a gun, knife or other weapon against a partner?

How many times have you ever slapped a partner or thrown something at her that could hurt her?

How many times have you ever pushed or shoved a partner?

How many times have you ever kicked, dragged, beaten, choked or burned a partner?

How many times have you ever hit a partner with a fist or with something else that could hurt her?

Do you have a male friend who uses physical violence against his female partner or wife?

A wife who earns more than her husband provokes violence at home